CN100591309C - Facial tissue strengthening and tightening device and methods - Google Patents

Abstract

A device is described that can be used quickly and accurately by surgeons to provide uniform facial tissue planes that are tunnel-free and wall-free thus optimizing face lifting, tightening, and implant delivery. The device is comprised of a shaft with a substantially planar tip further comprised of relative protrusions and energized relative recession lysing segments. Forward motion of the deviceprecisely divides and energizes various tissue planes causing contraction, especially via the fibrous tissues. Other forms of energy and matter can be delivered down the shaft to further enhance desirable tissue modification and contraction.

Description

Facial tissue's enhancing and take-up device and method

The application require on July 30th, 2004 application, denomination of invention is 10/903 for " FacialTissue Strengthening and Tightening Device and Methods ", serial number, the priority of 325 U.S. Patent application, this paper is incorporated in above-mentioned application by reference into.

The application is application on January 22nd, 2000, denomination of invention is " Face-LiftingDevice ", serial number is 09/749,497 unsettled U.S. Patent application, December in 1999 application on the 30th, denomination of invention is " Surgical Device For PerformingFace-Lifting Surgery Using Radio Frequency Energy ", serial number is 09/475,635 U.S. Patent application (present U.S. Patent No. 6,440,121), application on January 5th, 2000, denomination of invention is " Surgical Device ForPerforming Face-Lifting Surgery Using ElectromagneticRadiation ", serial number is 09/478,172 U.S. Patent application (present U.S. Patent No. 6,432,101) and 6/6/2000 the application, denomination of invention is " ThermalRadiation Facelift Device ", serial number is 09/588,436 U.S. Patent application (present U.S. Patent No. 6,391,023) this paper is all incorporated in part continuation application, above-mentioned application by reference into.

Technical field

The present invention relates to the face wrinkle-smoothing device.Yet more particularly, the application carries out face wrinkle-smoothing with those common pending applications by accurately consistent plane separate tissue, and the energy change that tissue is strained by freshly sepd tissue plane produces.Described device passes through the most small cutting action under the surface of skin.The present invention can only use the long otch of three 1cm to produce 1000cm in 20 minutes ²The move under water tip configuration of skin of face of above no wall.Although the present invention can be greatly and influenced the volume that big surface underneath is long-pending and organize equably, the use of device can be regarded as Wicresoft's cosmetic surgery, and reason is that clinical visible otch is less relatively and convalescent period is very fast relatively.The present invention also relates to strengthen the subsidiary method of separately organizing planar high energy effect by using organic and inorganic chemical and material simultaneously.The target of the application and related application is not stay remaining fibrous tissue passage with separating and separate people's tissue plane equably effectively under Wicresoft and the situation of avoiding epidermis fully, thereby solidify the blood vessel of can't see by way of parenthesis at a distance, and high energy ground changes the tissue that separates on the tissue plane both sides, thereby causes tissue contracts and enhancing by the formation of collagen.In addition, complete and uniqueness and the important additional function that effectively separates (not staying remaining fibrous tissue passage) of human face's tissue plane is the formation again by target wrinkle, fluctuating, fold or defective from the surface texture of their deep layer fiber adnexa interference surface of bottom cut-out.

Background technology

Animal and human's skin is formed by at least 3 layers usually.These layers comprise (i) outmost surface epidermis, and it comprises pigment cell and pore, and (ii) corium or cortical layer and (iii) (subdermis) under the corium it typically is fat, fibrous tissue or muscle.The current goal of the energy of most renovation process is the corium of mainly being made up of fibroblast.Fibroblast produces collagen bed and substrate, for example is used for the hyaluronic acid of corium.When for example damaging when getting muddled in corium, fibroblast is activated and not only produces new reparation and strengthens collagen but also contraction, thus tension and sealing rehabilitative organization.Collagen is the basic structure albumen of almost finding in all human bodies.It accounts for below 5% of epidermis, accounts for half of corium, accounts for subcutaneous approximately 20%, and this depends on ethnic group, geographical position, age and individual original damage.Directly collagen contraction is parallel to the axis of individual collagen fiber usually, when the dyeing back during with microscopic examination this axis roughly corresponding to the direction of collagen bundle.Pyrolytic damage to collagen might be caused by the hydrolysis and the forming again of hydrogen bond of crosslinked with collagen molecule, causes the loss of part or all of feature collagen helix.Virgin rubber is former in damage and some disease form; New collagen is scar tissue technically.However, scar tissue controlled and evenly to be formed on medically be favourable, and visually be desirable, this can formerly be subjected to the woman's of sunlight infringement face to carry out seeing under the situation of deep layer chemical peeling.Thereby, form new collagen with a kind of hope, uniform and controlled way and can cause tissue to strengthen and tension.It is said in people's face, do not have uniformity to have only distortion.

At present, need a kind of surgical device that has the following advantages: the otch Wicresoft ground that 1) only passes through three 3/8 inch inserts, with treatment entire face and cervical region, 2a) accurate level/tangential organized layer separates and does not stay remaining fiber (collagen) anatomic passages, but preserve neural and the vascular lamina mesh network keeps straight level to follow the tracks of with destruction corium is remained to more deep structure [from the teeth outwards as visible wrinkle simultaneously, fold, the slit is in sight] any fiber key, 2b) cutting tip energy applications, to such an extent as in order to solidify from the miniature incision invisible blood vessel of naked eyes too far away, because the use of endoscope trouble and consuming time, 3) direct surface undertissue energy applications ability, in order to change, cause or stimulate fibroblast/collagen to cause skin tension and strengthen, thereby walk around hypersensitization and fragile epidermis fully, thereby avoid visible surface scars and dispersion penalty/excessive.

The applicant satisfies following needs: 1) Minimally Invasive Surgery has visible hardly surgical device and enters wound, 2) patient recovers and treatment fast, 3) can use with the swelling anaesthesia agent, 4) avoid or walk around epidermis fully, 5) effectively separate and separate people tissue plane with cervical region with 20 minutes operating times facial, solidify blood vessel simultaneously, 6) can change the contiguous separately tissue of tissue plane simultaneously, cause that thus collagen forms again, shrink and enhancing, 7) destroy and be separated in fiber binding agent between corium and the darker skin texture fully, thereby will can not take place to form again and be connected again, therefore reduce the target wrinkle in the facial surface texture, rise and fall, the chance that fold or defective will occur after shrinking the treatment phase again.Current do not have device or method to solve all these problems simultaneously in medical literature.After inserting simple swelling anaesthesia agent, expertly carry out the face operation that comprises stitching and estimate to spend about 15 minutes.

Cutting (in the operation), dissolving (in the operation), sharp undermining and blunt undermining are defined in applicant's existing correlation technique.Sharp device undermining is the main dependence of plastic operation, yet even the skilled plastic surgeon of carrying out face wrinkle-smoothing also may be when carrying out sharp undermining " loss " correct tissue plane sometimes; Even have very high skills and experience, former operative scar or abnormal anatomical structures may hinder the operation perfection during sharp keen shears or dissecting knife carry out anatomic tissue/undermining.Non-sharp keen apparatus blunt undermining utilization circle, most advanced and sophisticated even people's finger is sought the path of resistance minimum between the tissue; In case the surgeon finds ideal plane, the benefit that blunt dissection provides is the chance that reduces the such key structure of damage or injury such as facial vessels or nerve (to facial muscle), reduces the chance of hemorrhage or permanent facial paralysis thus.Unfortunately, carry out the irregular passage that blunt undermining causes having the thick fiber wall between the high fiber tissue in being present in the human face separately.

Use the shortcoming when the front face regeneration techniques of laser in those patents of aforesaid referenced patent and applicant, to be described.Manually the current face wrinkle-smoothing apparatus that cuts of energy can not provide uniform no wall tissue plane during the face wrinkle-smoothing of energizing is dissected.Current laser must be launched that the tissue of thinking the face is energized from the position of patient outside natively and use the auxiliary face wrinkle-smoothing method of current energy to cut (referring to Cook in very coarse mode, R.C. and Cook, K.K, Lippincott, Williams, and Wilkins, " the swelling fat moulding laser cosmetic surgery guide (Manualof Tumescent Liposculpture and Laser Cosmetic Surgery) " of Philadelpia, ISBN:0-7817-1987-9,1999).The degree of accuracy of current treatment, change or destruction deep dermis is little.The complication that aforementioned techniques causes is summed up in Dermatologic Surgery 26:625-632 in 2000 by people such as Jacobs.

Use the shortcoming of the current face wrinkle-smoothing technology of electro-surgical device in those patents of patent of quoting and applicant, to define.

For everyone provides their pigmentary color and the tissue layers of the skin of quality is corium.Unfortunately, each skin regeneration system basically (except injectable skin filling compound) of existence or even traditional face wrinkle-smoothing operation (when consideration is cut by the skin around the ear) must be through epidermis to attempt arrival and treatment corium so far.To epidermis and form the imperfect painted or colour loss that structural damage usually causes skin, this can see in cicatrix.But scientists and engineers's main consideration about skin regeneration operation in 10 years in the past is the destruction of how to exempt thin crucial epidermis and adjacent last skin corium.

The present patent application will point out obvious damage to tissue plane for example subcutaneous (fat) layer of contiguous corium can cause the relative overlapping layer contact of corium, supposes it is because the cell between inflammation vehicle or the plane is crosslinked as the report of first submission.In addition, the orderly and accurately formation (new collagenation) of new collagen can cause ideal tissue enhancing and tension in the corium of the present invention and relevant patent.Along with human face's skin aging, the surgeon is used to sew up some facial the strongest organized layers of tension, promptly is called as the fibrous layer of fascia or SMAS (superficial musculoaponeurotic system), becomes thinner and more weak.Disease and environmental factors for example diet and Chemical exposure also play their effect.Various embodiment of the present invention can pass through along activating fibroblastic these layers, increases collagen quantity because the wound that device causes or change in organization's energy accurately are transported to the uniform formation plane that device produces, and wears out layer thereby thicken and strengthen.If need further to strengthen in big, accurate, the bloodless surperficial lower plane that device only uses that three 1cm mini-incisions set up, then three miniature incisions allow reinforcement grid, tether, hoist cable organic and/or inorganic material and facial implant manufacturing are incorporated in the face.As far as we know, never described the hypertrophy therapeutic agent in the past and be used for facial tension or enhancing, this may be because not can be used for accurately producing at present the potential hypertrophy therapeutic agent chemical gradient effect planar apparatus of even facial tissue thereon.After the facial tissue plane that the invention of same Applicant causes forms, hypertrophy can be treated fluid and be expelled in the miniature incision with the effect that strengthens device at that time or cause they self main influence.

The segmentation photo-thermal dissolving of applications is different from the present invention and correlation technique.Segmentation photo-thermal dissolving (FP) (is published in Manstein D Rox Anderson open recently " dissolving of segmentation photo-thermal: a kind of hot injury's of use micro-pattern is carried out the new ideas (Fractional Photothermolysis:A NewConcept for Cutaneous Remodeling Using Microscopic Patterns of Thermal Injury) of skin remodeling ", Herron S, Tanner H, Laser in Surgeryand Medicine with Anderson R, the 34th volume, the 424-438 page or leaf, 2004).Anderson says: " demand for the effective and safe laser therapy of repairing photoaging skin increases.Developed two kinds of therapeutic modalities, melted skin resurfacing (ASR) and non-ly melt corium transformation (NDR) and solve this demand.Yet all current available laser therapies have typically safety and working effectively in therapeutic domain narrow and small, that depend on the patient only of significant problem and these laser systems." main cause of narrow range is too fragile epidermis.The Anderson suggestion: " efficient that studies show that treatment fold (wrinkle) and solar elastosis improves [document 9 of Anderson] along with the increase of the pyrolytic damage degree of depth.The most effective erbium: YAG (yttrium-aluminium-garnet) laser that is used for the treatment of fold uses the longer pulse duration to increase the residual heat infringement degree of depth [document 10].In order under the situation of not sacrificing efficient, to strengthen the wound rehabilitation, combined method catch on [document 11] for ASR.In order to overcome the problem that the ASR operation brings, so-called NDR technology has appearred, and this choice of technology ground destroys dermal tissue to cause wound response, still avoids destroying epidermis [document 12-25].In this technology, realize not destroying the controlled corium heating of epidermis by laser therapy and the refrigerative combination of correct periodic shallow epidermis skin.The reparation of formation that the wound response of pyrolytic damage dermal tissue is caused new dermal collagen and the tissue defects relevant with photoaging.The disappearance of NDR technology mesocuticle infringement has significantly reduced the seriousness and the persistent period of treatment related side effects.The laser that is used for NDR operation have than shallow table absorb melt erbium: YAG and CO2 laser is firmly got the light penetration depth of Duoing.Can avoid epidermis to destroy although shown these technology, the major defect of these technology is efficient limited [documents 26] ".Anderson measures and report only has 2% tissue contracts result: " ... little but renewable, observe contraction of skin when measuring when placing by little tatooing (microtattoo).Contraction of skin was still obvious afterwards in three months in treatment ... "Anderson is tangible to especially minimizing the destructive concern of permanent epidermis in the more black patient of skin.In our research, several casting skin objects are arranged, they show seldom or unconspicuous pigment anomaly at each treatment after the FP of low or middle MTZ (micro-area for treatment) density.The histology shows that existence use MENDs (the downright bad fragment of little epidermis) discharges and transport mechanism as the melanin partial, well-controlled of " media ".

The FP of the described applications of Anderson is different from the applicant.The FP device of Anderson must be placed on the external skin surface and not be described in the inner skin that uses with the skin of path arrival internally.The FP device of Anderson is outside, be not designed to, and it can not be designed to the fibrous tissue under the deface skin and come at the tip that does not have another adnexa or install applicant for example can not be by under the skin under the situation in " opening ice " path.Do not destroy the fiber key that surface skin is connected to facial more deep structure under the skin surface, described more deep structure is for good and all in conjunction with wrinkle.Unfortunately, surface treatment only is temporary transient and only causes small tension.The applications technology of Anderson must limit power transfer, and this only produces 2% tension for fear of the epidermis that destroys fragility.Anderson uses and allows time enough and space the long MENDs of damage promoting epidermization (the downright bad fragment of little epidermis) to take place to avoid the permanent destruction epidermis.Applicant's embodiment produces MEND even local large tracts of land necrosis (FMN) and conveying capacity on external uniform formation plane internally, allows the homogeneous energy gradient, therefore walks around fragile and epidermis sensitivity, and the people causes darker tissue contracts simultaneously.Applicant's US6,203,540 relate to cuprammonium rayon hollow, and it can be pulsed under skin and carry to cause the damage of similar FMN.Described fiber size will provide the size energy bigger than MEND to destroy pattern; Yet, US6, optical fibers size in 203,540 can reduce causing than the size of MENDs slightly greatly or approaching with it destruction volume and upwards discharge more multipotency than Anderson towards epidermis, and reason is that bigger corium changes and has minimized epidermis influence.Shift owing to can carry out bigger direct internal energy, the applicant allows to treat bigger surface area fasterly.Under skilled situation the applicant 20 minutes with interior operating time treatment entire face and cervical region to clavicle.In 10 * 10 square centimeters the grid of tatooing on the piglets abdominal part that size doubles during 3 months research, the device of Anderson only carries in the tissue 2% tissue contracts to measure under not increasing tensile situation, by comparison, the applicant has the contraction (not announcing, if the available photo of words that requires) of 20%-30%.Result's difference is owing to the greatest differences in being transported to the energy of tissue between two kinds of methods to a great extent.(in order to emphasize to have increased underscore).

Laser therapy tissue and electrosurgery treated tissue are similar aspect several.Yet, when beginning when internal electrical modification people organizes, to the most important thing is that the tissue regions of partial vaporization has higher electrical impedance at once, and increase voltage difference, thereby further change the treatment that local electricity penetrates/organizes.The thickness fiber channel irregular and irregular formation that use is different from applicant's device generation carries out energy absorption, thereby will cause visible irregular skin surface influence to rehabilitation.Other major reasons to planar applications change in organization of the facial tissue energy of accurate formation under the situation that does not have fiber channel wall residue comprise: " electrical impedance of known tissue is owing to reducing around the increase along with frequency of the electrical property of the cell membrane of conduction Cell sap.Because higher tissue impedance, current flux lines often penetrates not too deeply, causes organizing the degree of depth of heating littler.If will realize the bigger degree of depth of tissue heating, then must use higher output voltage and frequency.More low impedance path will cause more the low resistance heating automatically, and what reason was heating with operating current is square proportional with the product of impedance.”

The monopolar electrosurgical apparatus has single active electrode on the tip of electrosurgical probe.The low-voltage that is applied to the active electrode that contacts with destination organization moves to dispersion earth plate or indifferent electrode with electric current by tissue and patient.Voltage difference between active electrode and the destination organization causes electric arc to form on the physical clearance between electrode and the tissue.In the acnode that contacts with tissue, owing to tissue heating fast takes place the high current density between electrode and the tissue.Electric current density causes Cell sap to be vaporized into steam, produces cutting effect.The monopolar electrosurgical method is returned or the definition path guide current of ground electrode along entering by patient's body from effective apparatus electrode usually.The minor diameter electrode increases partial electric field intensity.Bipole arrangement is more easily controlled flowing of electric current around the effective coverage of therapy equipment, and this has reduced the hot injury, thus make tissue necrosis and and give birth to disorganization and minimize, reduce conduction of current simultaneously by the patient.The applicant believe will be with the optimum organization of the most advanced and sophisticated electric flux that be used in combination of protection in the dissolving section the one pole cutting current and along the auxiliary one pole or the bipolar coagulating current of the in-plane of device.Because the applicant finds that facial high-resistance low fat layer plane of dissecting can by electricity or energy damages and finally cause medium to be transferred in the corium eclipsed, that upward cover, cause its contraction (might be caused by inflammation chemical mediator or cell transfer), more inevitable than bipolar higher energy mode in theory (subcutaneous the most pure virginity skin lesion is hindered inflammation and is shunk transfer effect=SDTISTE) and make the fat deposit necrosis because transfer effect takes place.

The US5 of Eggers, 871,469 is different with the applicant with relevant patent.Eggers has instructed a kind of electro-surgical device, and this device needs ion fluid to produce conduction between small array electrode and dependence is optimally worked from the ion flow body source of apparatus inside.Eggers instructed mainly depend on microelectrode that selected embodiment arranges in every way to or group between bipolar energy flow.Unfortunately, the vertical view of Fig. 2 c of observation Eggers may stay the similar wrong impression of shape at shape and applicant's tip; Yet outstanding in Eggers is electrode/conductor, if attempt even may produce the plane, described electrode/conductor will disturb and destroy the key facial tissue structure that comprises the people of subdermal vascular plexus in the way brokenly.Applicant outstanding is nonconducting or insulating protective and is convenient to accurate device and moves that no wall tissue plane forms, and provides following clump of key corium to organize preservation simultaneously.The embodiment at the electrod-array at tip of Eggers can be compared with the composition file of drill for oil well, wherein array outstanding nip and machonnement in destination organization, to form groove, Expected Results is opposite fully with applicant's invention and kinetics.In order to quote the US5 of Eggers, go in 871,469 the 4th hurdles the 49th: " electric field is vaporized into thin layer with conducting liquid at least at least a portion of effective surface electrode, make the ionizing of steam layer then ... "The thin layer of conductor fluid is optimized in Eggers instruction vaporization; The additional application of conductor fluid is dispensable for the applicant.Eggers has disclosed on the 11st hurdle in addition: " the downright bad degree of depth (tissue die, lethal changes) will be typically between the 0-400 micron and usually the 10-200 micron (=0.2mm) between ".It is 4mm (4,000 microns) that the energy level that the applicant produces allows the disorganization degree of depth, bigger more than 20 times than the safety range of Eggers.Only the applicant can produce no passage, Wu Bi, uniform tissue plane, and application organizes is modified energy or organized and modify chemicals and produce uniform gradient electromotive force on described plane.The US5 of Eggers, 871,469 external skin resurfacing (Visage

) need the outer ion fluid to instil and use clinically, known its can not be removed thin more much smaller wrinkle under the situation that does not have variation of epidermis pigment or cicatrix.Visage

Only can reduce the thinnest wrinkle.Eggers fails to be described in and does not form any outstanding-depression organization protection tip capable of giving energy of following the tracks of reliably under the situation that passage maybe can produce the planar remaining conduit wall of uniform formation, shifts energy on described tissue plane equably.If there is not the uniform tissue plane to energize equably, just do not have the uniformity of tissue contracts.

The United States Patent (USP) of Eggers: 6,740,079 and 6,719,754 and 6,659,106 and 6,632,220 and 6,632,193 and 6,623,454 and 6,595,990 and 6,557,559 and 6,557,261 and 6,514,248 and 6,482,201 and 6,461,354 and 6,461,350 all are bipolar basically and need to be positioned at FLUID TRANSPORTATION element on the probe or on the part of individual instruments.Alternatively, Signa Gel or spray foam can be applied to destination organization.All all can not produce passage does not have facial plane wall, fully uniform, and energy is on described plane.' 559B1 instructed that single platypus mouth is shape, asymmetrical positioned, " atraumatic " preventer, it can not produce passage does not fully have energy facial plane thereon wall, fully uniform, and reason is that single preventer will produce passage heterogeneous and be deflected into the zone of resistance minimum by them.' 354B1 needs bipolar electrode to keep " during ablation procedure from the distance of destination organization 0.02-2mm ... keep this space ... with respect to organizing laterally translation or rotating probe (brush) ".If the tissue darker zone solidify or collagen contraction is necessary (blood vessel that sealing is imbedded) ... push electrode terminal ... the joule heating.If it were not for complete infeasible device as inner, facial tissue Wicresoft, complete decorating device, 354B1 self is impossible, reason is that satisfying in this requirement that does not have under the situation of endoscope blindly to push is impossible with sealing away from the invisible blood vessel that the limited incision end reaches 10cm, thereby cost a few hours are finished operation (less than beginning and finish whole traditional face wrinkle-smoothing).According to ' the 8th hurdle of 350B1, be trouble the operating in the operation of situation bleed bottom blood vessel that does not have endoscope, if because with ' the just described same cause of 354B1 is carried out blindly from limited incision, is impossible in operation then.' 350B1 rely on the electric energy found in the bipolar design relatively a little less than; The electric circuit inspection and the interruption that have alarm can not be preserved nerve, and this relies on geometry with the applicant and keeps accurate location and dependence sense of touch to handle away from known nerve location to be avoided infringement opposite in motion.Applicant and other facial surgeon disagree with that Eggers exists ' statement among the 261B2: the remaining thermogenetic 150 degrees centigrade temperature of probe can sealing blood vessels; Those dissenting people quote in the middle-sized branch of the hemorrhage situation lower face tremulous pulse that has hiding distance from the mini-incision position as an example.In all patents of Eggers, especially exist ' among Fig. 3 of 193B1, X-Y scheme may be similar with those of applicant at first view, yet highlight in cylindrical base, and conduct electricity, nonisulated, nonlinear arrangement, and between them, do not have the dissolving section.' but 248B1 uses the side direction that occurs from the side of lip pencil cover shape probe to launch and the antenna that reclaims is revised more accurately and is used to cut and organize volume electrosurgery electric arc.' 248B1 is by using based on the described part of edgewise electrode and the cutting device that can not place the fragile bottom surface that is used for the uniform dissolution face and different with the applicant.' the side direction line of 248B1 will be forced to along with the regional relative direction of the maximum fibrous structure of contiguous non-homogeneous dissolving passage, thereby cause result heterogeneous.' 079B1 is Electrosurgical generator, it can carry discharge arc uniformly at the tip, thereby carries more accurate cutting ripple.' 079B1 uses the active electrode have the dynamic effective surface area that geometry changes, yet applicant's geometry is significantly different, reason is ' 079B1 can not produce the fully uniformly facial plane of no conduit wall, and this will have a negative impact to the uniformity of tissue plane energy absorption.In addition; the protection that the geometry of ' the one pole cutting current of 079B1 energy window/zone of collagen/fibrous tissue rhetorical function modify to(for) applicant's tissue be nonideal and will damage the fragile downside of facial corium and corium clump greatly that reason is described ' 079B1 and expection the lacks the applicant such key structure of outstanding protection that insulate.In fact all patents of Eggers have been instructed bipolar electrosurgical; As described in Eggers, bipolar electrosurgical produces " plasmasphere is limited in surface layer to minimize the infringement and the necrosis of covering weave down with the molecular breakdown process " subsequently ideally.Do not have irregular defective in order to cause covering the obvious all even safe modification of corium and epidermal tissue, do not have applicant's geometry and adjacent energy function for example necrosis be impossible.Do not lack significant tension effect owing to there being permanent epidermis to change or scab, see Visage

Only be confined to be used for cosmetic surgery and salon; Use at high-energy level more and to cause nonideal surface skin to scab.

The US6 of Goble, 210,405 have instructed a kind of Eggers of being similar to carry out the electrosurgery file device of work.Goble has instructed a kind of " file " installs, and this device produces the vapour bubble that need aspirate around destination organization, and this instructs the apparatus that smoothly advances that need not file the target surface that weares and teares opposite with the applicant.Goble instructed the plastic operation of the solution that need to be used to like saline and urology procedure " ... to fill and expansion cavity ... ", this is opposite with the existing correlation technique that applicant and applicant do not have.Goble has instructed a kind of apparatus, and this apparatus is used for " brush ... compacting ... moulding and level and smooth ", this with applicant cutting with smoothly to pass through destination organization opposite, described destination organization is not removed but by energy change and stay original place transformation.Goble needs ion fluid pump and aspirator and mentions and need endoscope to help, and this is opposite with the applicant.The applicant has instructed device only by feel, that blindly operate, and wherein pump or aspirator are preferred." file " as the file effect of Goble instruction comes " wearing and tearing ", these are different with the previous word " file " that uses of applicant, and this only is the sensation that the manipulate surgical doctor obtains when device successfully passes through in correct fiber-fatty facial tissue plane.

Hayward, the Thermage company limited of CA introduce market with the tissue contracts product of its applications electrosurgery template that is activated recently when contact is outside.Energy passes through epidermis, thereby makes energy pass through epithelium, and purpose is that electricity changes collagen to realize transformation; By on the epidermis when the electric pulse in the target area from external spray approximately-40 ℃ cryogen (refrigerating gas) reduce destruction to a certain extent to epidermis.Unfortunately, the tissue contracts amount of Thermage company limited proves statistics insignificant (quoting several famous esthetic surgery doctors) and is far smaller than 5% in the medical literature scope.At present, have whether there is the significant improved free discussion of statistics in skin face-lifting educational circles about tissue contracts at all relevant Thermage.The US6 of Stern, 413,255B1 relate to the device of Thermage and be applications " tissue contacting surface ... and have the variable resistance part ".' 255B1 instructed the linear array of applications bipolar electrode; Use the applications monopolar electrode embodiment of refurn electrode also to be shown.About the electrosurgery conveyer device ' fundamental right among the 255B1 requires to point out to contact with the outer surface of skin.The United States Patent (USP) of Knowlton: 6,470,216 and 6,461,378 and 6,453,202 and 6,438,424 and 6,430,446 and 6,425,912 and 6,405,090 and 6,387,380 and 6,381,498 and 6,381,497 and 6,337,855 and 6,377,854 and 6,350,276 and 6,311,090 and 6,241,753 and 5,948,011 and 5,919,219 and 5,871,524 and 5,755,753 have obtained the permission of Thermage company limited.Knowlton exists ' mention that " method of the present invention does not provide the total necrosis of cell among the 498B1.But ... the partial denaturation of collagen allows it to become tight ".For the needs of " tissue tension and do not destroy the intervention of maybe need not performing the operation of melanocyte or other epithelial cells ", Knowlton has quoted US5, and melanocyte (pigment cell of epidermis) is protected in 143,063 failure.The aforementioned techniques of Knowlton thus be classified as noninvasive, so in epidermis, do not relate to the otch that causes disorganization or expection opening.Opposite with the aforementioned techniques of not mentioning the Knowlton that inserts by skin, applicant's Technology Need otch; To such an extent as to the device of Knowlton is unsuitable for any Minimally Invasive Surgery position too greatly.The controlled shrinkage of collagen that is used for the fibre diaphragm of subcutaneous fat ' the 854B1 method is considered to undesirable widely in medical circle.The tractive mode separation strapping causes the pcketing of surface skin.This is because the current membranous result of high shrinkage that is considered to of liparitosis (undesirable problem), causes under the skin course pcketing towards fat deposit.' Knowlton wants to produce the degree of depth of moderate burn only to scab in inside on tissue surface among the 753B1, thereby on the zone such, produce tissue contracts such as the bone corpus callosum on the periosteum, and claim: " this method is particularly useful in and lacks collagen or the insufficient tissue site of collagen ".' among the 753B1 Knowlton mention described device can percutaneous, carry out by skin or by endoscope, it is because epidermis deficiency (sparing) is produced by subsurface heating that Knowlton also mentions reverse thermal gradient.The principle that transmits electric power on medical apparatus and instruments under skin is not novel, and only the use of the specific implementations of Knowlton is novel.Yet similarly the energy percutaneous is carried for a long time and is just used by the surgeon, for electrosurgical at least from 20th century the eighties count mid-term, for laser surgery from 20th century the nineties when Cook percutaneous guided laser shrinks the lower floor corium of cervical region, count.Age, existing one to two many endoscopic technique more than century allowed percutaneous to carry electrosurgical and or laser.Maximum difference is ' 753B1 fails to provide a kind of means to produce the uniform in-plane tissue surface, on described tissue surface with uniform mode conveying electronic energy.Irregular target surface produces irregular electronic energy gradient.The applicant can provide the new homogeneous band that separates facial tissue to handle, and described homogeneous band does not have the fiber channel wall; Thereby eclipsed collagen can be handled equably by following energy source and gradient and can not produce the overlapping skin that comprises epidermis and striped occurs or form band.' 753B1 do not provide means or implementation method ' 753B1 device to allow Wicresoft real estate means of livelihood footpath, in described path freely by and do not form passage or destroy strong fiber obstacle.Knowlton exists ' Fig. 2 A of showing among the 276B1 shown a kind of " conductor ", this conductor is roughly similar with the applicant on two dimension; Yet this only is only drawn on two dimension because have the columniform 2A device of the outstanding interface channel that is used for cable, conduit, seal wire, backguy, covered wire, optical fiber and finder/display, and three-dimensional consideration has disclosed greatest differences.Knowlton exists ' description on the 4th hurdle of 276B1 mentions device and is connected to template to receive body structure.' 276B1 obviously mentions and only be designed for the outside organization's (or other outer skin shape mucosas) that will contact with template.All the other patents of patent group are about ' 090 and relate to the applications device that is applied to external skin, it has the ion-permeable porous membrane that uses electrolyte, described thin film with mode to the small part that is similar to rubber fit in (' 202B1 on the external skin surface instructed to expand be used for the thin film of body make-up); One pole and bipolar embodiment are provided.Such device want to make emittance (be defined as causing any kind of cell heating or physical damage, comprise RF, microwave, ultrasonic etc.) in uniform mode by epidermis and use cooling chamber and surface cool fluid that epidermis is destroyed to minimize.On the other hand applicant and applicant's previous related art teachings a kind of internal probe that has particular tip, the described tip accurately face by the people provides no channel plane dissolving to keep following the tracks of sensation simultaneously.Even so, the energy shortage that passes through simultaneously refrigerative epidermis application of the many disclosed US of studies show that ' 255B1 is approved of so that comparison film wrinkle or tissue tension the consistent of moderate improvement to be provided.On the contrary, applicant and applicant's previous related art teachings energy level on flow, want much higher and walk around the epidermis of hypersensitization together.Applicant and applicant's previous correlation technique might not need to spray cold-producing medium and reduce the epidermis heating so that remarkable bigger power level is delivered in the target corium.

The US5 of Bruker, 500,0012 with to use laser, optical fiber, radio frequency, other therapeutic combination energy devices previous correlation technique with applicant and applicant on their intrinsic shape ultrasonic or microwave different, and described shape is generally catheter-like, flexible, cross section is circular.Flexible conduit can not self penetrate facial fibrous tissue.Such device means between organ mobile so that the one or more execution in them ' point ' are treated usually.It should be noted that in Fig. 4 of Bruker electrode 18 and 20 is with helping detect electric ARR detecting electrode, and to give prominence to any similarity of section obviously different with the insulation of applicant and applicant's previous correlation technique when considering X-Y scheme resembling Eggers in three-dimensional.Bruker does not have rigidity with along correct fibrous face facial planes route and boring or passage or be directed simply as flexible conduit in the path of resistance minimum.The similarity that only has between Bruker and applicant and applicant's the previous correlation technique is that Bruker can be carried to heart cell with the fluid toxic agent; Yet it is the tissue plane of modifying even generation equably that the applicant uses prolotherapy with device.Electrod-array among the Bruker detects the electrode around the tip that is positioned at Bruker, wherein has the single therapeutic electrode of energizing, and described therapeutic electrode only breaks away from or instantaneous stretching out from catheter channel when needs kill wrong electrically excited heart cell; The outstanding array of Bruker do not launch at the volley usually and might be by during movement being attached at tissue interfering movement, so Bruker outstanding do not help the device motion.

Such as the US5 of Keller, 445,634 and US5, single chamber of 370,642, circle or non-circular cross sections laser conveyer device need use incidental endoscope usually.Endoscope is awkward optical instrument, and it need use two handss that it is directed to destination organization when the surgeon operates the apparatus of Keller usually, this difficulty really.The difference of Keller and similar device is to lack the most advanced and sophisticated configuration in plane of relative outstanding non-conductive protecting component of associated recesses of energizing having of applicant.Applicant's technology can be operated by the surgeon under the help that does not have endoscope blindly, reason is that device provides instant continuous feedback by simply touching " sensation ", thereby the surgeon can easily grasp with T unit is correctly mobile in tissue mutually definitely.Device such as Keller can only be carried out a driving, unless the surgeon also uses endoscope to focus on certain type the dissipation energy of organizing along whole tissue plane; Unfortunately, maintenance will be consuming time and difficult with the plane motion that Keller works in coordination with.The result of Keller has discussed use He ' 632, ' 634 is limited in passage.

The US5 of Loeb, 984,915 have instructed and have only made the facial subcutaneous skin histology of single bare fibre by the people.Yet Loeb does not instruct tough and tensile and any shell or the rigidity or the semirigid structure fibrous people's fiber-fatty facial tissue that can allow bare fibre to pass through not dissect.Loeb statement and declaring in the 6th hurdle the 55th row: " optical fiber is bare fibre ... most advanced and sophisticated skin puncture and advance in the subcutaneous tissue when sending laser energy ... "Loeb further instructs at the 9th hurdle the 14th row: " diameter at the tip of optical fiber is in the scope of about 25-100 micron (＜0.1 millimeter) ... preferably approximately 50 microns ... "Those skilled in the art knows easily and can not organize the such thin optic fibre of propelling to have any uniform clinical effectiveness by relative not penetrable human face.If inhomogeneous on face, the people just has deformity.Anatomical structure in view of the human face, wherein corium is made up of near transparent hardly collagen fiber of football skin density, and wherein subcutaneous layer of fat comprises the collagen fiber barrier film, although do not resemble the fat deposit of abdominal part fine and close, but described collagen fiber barrier film is fine and close relatively, Loeb can not produce even effect and can not resemble allow in ' 915 can implement.The difference of applicant and Loeb is that the applicant provides the relative stiffness of holding energy element structure, thereby described energy element can penetrate the extension fibre diaphragm net of facial hypodermic layer and provide the uniform tissue surface to enlarge the collagen that changes this facial layer effectively.Loeb has instructed in the table 1 the pulsation energy level that is used for " wrinkle of skin removal ", even with the optical fiber of a hair thickness impossible task by fine and close relatively facial fat deposit is possible, will spends a few hours to a couple of days based on the fibre diameter of Loeb and shine effectively or treat entire face.It should be noted that collagen gathers particularly compact in most facial wrinkles, further unfavorable to Loeb.

Term wrinkle resectoscope (rhytisector) is the combination word that is derived from (rhyti=wrinkle)+(sector=cutting or removal).Described instrument is inserted under skin usually in natural fold, fold or the finedraw of target wrinkle one segment distance for the treatment of " removal ".The wrinkle resectoscope is made " Y " shape device by metal, and between 8cm and 16cm, the arm of the V of Y part is approximately 3-4mm to the axle of Y/base portion length usually, and the base portion of wrinkle resectoscope (acute angle) is thin and sharp keen basically usually.The wrinkle resectoscope of discussing in medical literature is flat fully when flatly observing from the side and will never be energized by electric.The use of wrinkle resectoscope sharply reduced in the past in 10 years.Unfortunately, the wrinkle resecting tool has caused the reputation of bleeding profusely, and causes injury with blood-stasis, hematoma (blood pond) and undesirable vascular tear (disconnection).This is owing to sharpened edge to a great extent and can not solidifies.The applicant has searched for many main electrosurgeries and plastic surgery/medical apparatus and instruments manufacturer: Bernsco, Ellman, Colorado Biomedical, Conmed, Delasco, any wrinkle resectoscope that resistance can be arranged charged or is not basically mentioned in catalogue before the Snowden-Pencer, Tiemann and Wells-Johnson1999 and discovery on the distal tip of " Y ".Even the wrinkle resectoscope is similar to the applicant and is insulated, but the shape difference, and reason is that the wrinkle resectoscope is very thin and same flat apparatus.

The U.S. Patent No. 5,776,092 of Farin has been described a kind of single hose system, and this device can transmission laser, ultrasonic or radio-frequency unit is with treated tissue.Yet the device of Farin is not to be used for the chorista plane and to be easy to stop, to tear or to puncture tissue when operation.Difference between the device of Farin and those similar devices is described in the application and those common pending applications.

The difference of using the ultrasonic liposuction intubate to carry out face wrinkle-smoothing or face tension and this patent application is described in the application and those common pending applications.

Exist general crowd's specific subgroup can benefit from the present invention uniquely.Caucasia men and women's skin of face and substructure are sagging and form fold in beginning between 45-55 year.Asia, Spain and African blood lineage's patient will experience the same phase of this situation, but the age a little later.In order to hide cicatrix, the current long otch of around every of two ears, making 10-20cm; The skin remaining skin that is cut off and abandons and stretch.Unfortunately, skin does not respond stretching and removal and thickening; It is attenuation only.Early stage in nineteen nineties, some plastic surgeons advocate in the time of more than 40 year old they to be carried out " prophylactically " or " in advance " face wrinkle-smoothing the woman, and it is said can " perpetual youth ".This theory of " preventative face wrinkle-smoothing " is suspected by most famous surgeon now to a great extent.

A kind of device quick and that secure alternate is selected that provides is provided for the defective and the deficiency of known current face wrinkle-smoothing and skin tension technology.The present invention utilizes the dissolving design of energizing of the uniqueness of contiguous various phase Sihe different-energies to cause tissue contracts.The invention provides a kind of enhanced method of human or animal tissues that is used for and realize face wrinkle-smoothing, facial tension or the tension of non-facial tissue.Described apparatus and method can be used for hospital and apace based on the operation of clinic and make pain and the risk minimization of damage.

Summary of the invention

The purpose of this invention is to provide a kind of method and apparatus, the surgeon can use described method and apparatus to provide quick and accurate face wrinkle-smoothing, tissue to strengthen or tension, and manipulation is a Wicresoft, can be carried out fast, and patient's recovery is very fast relatively, reduces pain and side effect simultaneously.

Another object of the present invention provides a kind of surgery face wrinkle-smoothing device, and described device easily keeps correct anatomical planes, dissolves equably simultaneously and provide energy delivery is strained and enhancing to cause skin histology to the planar ability of uniform formation.

Another object of the present invention provides a kind of shallow cut device, and described device can will dissolve during the face wrinkle-smoothing of no passage and no fibre wall that surface alignment is controlled to be used in proper level, the separating with uniform fibers-fatty tissue of safety.

Pointed shape is as follows with dimension definitions: bulb-with thinner adjacent dissolving zone is compared when having how much of the cardinal principles of ball from the top or during top view or round-shaped tip is given prominence to; The adjacent area of dissolving section-when from top view and the shape with ball is the tip region of attenuation relatively; Relative projection-relatively when from the observation of at least one angle, have the cardinal principle geometry of ball or give prominence at round-shaped tip with thinner adjacent " the dissolving zone " of relative depression; Relative depression-when looking the tip region that caves in relatively with relative projection when at least one angle is observed.

Described device is made up of hollow that has the opposite planar tip or solid shafting, and described tip can easily be positioned and remain between the anatomical planes in the tissue, is handled with chorista plane equably then and dissolves fibrous tissue fully.Cook has illustrated that with limited mode very the effect of the applied energy of collagen to face (corium, shallow table platysma tissue and other) tissue can cause contraction and strains in the face wrinkle-smoothing plane in medical science and other scientific literatures.Therefore, the present invention also provides energy source and conveyer device, and described conveyer device is with the far-end of energy delivery to axle.Many forms of energy can be used to the various piece of device to energize, and comprise polychromatic light, monochromatic light, laser, radio-frequency electrical energy, vibrational energy, ultrasonic energy, microwave energy, heat energy (hot and cold), chemical energy or their any combination.The applicant can be with sizable power transfer to subcutaneous tissue, and inflammation that produces on the separating plane in overlapping corium and medium cause inflammation and contraction thus.

Preferred implementation of the present invention has a plurality of protruding members on the far-end of axle, is called as the tip with the free burial ground for the destitute here, and described protruding member is wherein dissolved section and caved in respect to protruding member by at least one gap dissolving segments apart.Axles planar, circular or how much can stop in certain geometry at tip, and are crooked slightly or geometry though described tip is planar basically in rectangle, depart from the plane slightly.From top or below the pointed shape seen can change, and can be circle, square, rectangle, zigzag, scalloped shaped, groove shape or geometry.Also can use crooked and Seem Lablab Album shape.The pointed shape of seeing from front view can change and can comprise ellipse, rectangle, zigzag, scalloped shaped, groove shape or geometry.Although a favourable embodiment provides the axle with smooth or planar shape of cross section, the acceptable alterative version of axle can be oval, circular, trapezoidal or geometry on cross section.Although embodiment provides the tip that has the shape that replaces projection and depression, the acceptable alterative version of pointed shape can be semicircle, lenticular shaped or geometry.

For middle and bottom face wrinkle-smoothing/tension surgeon only before ear with chin under skin in manufacturing three or above relative little otch.By surgical hands the axle of device is applied forward with lifting force then and repel key structure (nerve, blood vessel), thereby avoid the entanglement or the damage of these important structure or be not cut with making any distinction between with the shape of separating and keeping tissue plane equably and install simultaneously.The same projection (in most preferred embodiments) that relies on they and the relation of cutting depression section to repel key structure also is used for locating the degree of depth of the present invention with respect to following corium.The tracking of the projection (ball) and the spacing holder tool of relative depression (dissolving section) relatively.The beneficial feeling of " tracking " can be touched immediately in the device motion by the surgeon and not need monitor to know how device moves.The number of projection in one embodiment and interval will help to reduce to wave or side direction (level) slippage during pushing ahead axle.Vertical slippage is under an embargo equally in one embodiment; Correct distance between the part of the width maintenance dissolving/depression section of projection/ball and the fragile downside of shallow epidermis skin or corium, a described part comprises the important blood supply from dermal vascular plexus.The ground that is highly profitable, the tip of device and the action of device can not needed direct demonstration (endoscope) by sensation/perception.Whether the surgeon can follow the tracks of in correct position by sense of touch ground sensory device; When device can be told customer location and the undermining amount that takes place in described position immediately along with touching when moving through facial tissue with easy fractionated resistance the sensation of device.Uniquely, this device produces the uniform formation plane, can be energized equably in described plane.By after stayed no fibre wall passage or irregular fiber ridge heterogeneous, this will cause irregular energy gradient.

Use projection/concave form, laser energize form, monochrome/polychromatic light form, hot form, low-intermediate frequency " routine " ultrasonic form of energizing, high frequency ultrasound energize form, back and forth form of energy and electrosurgery/radio frequency energize form, heat/add hot iron energize form and microwave powered form embodiment the application, those are common unsettled and the application of announcing in be described.

Prolotherapy (unconventional) can use in conjunction with instant surgical device.Using to prolotherapy of instant surgical device provides unique accurately to realize separating facial tissue plane.As far as we know, the use of prolotherapy (traditional or unconventional) is also by the internalist methodology of record in conjunction with skin regeneration.If someone thinks that prolotherapy is that stimulus compound is expelled in the health to stimulate strong collagen reaction, then above conclusion is correct.What arguement can take place is to stimulate for example deep layer chemical barking (with monoxone or phenol) of externalist methodology that the fibroblast/collagen of surface skin forms again, yet at surface skin: fragile epidermis not have their influence under the situation of cardinal principle and permanent deformation can not reach aspect skin darker.

It below is the brief background of the unusual theme of the prolotherapy that obtains from available medical literature.Prolotherapy is also referred to as non-surgery ligament and rebuilds, and sclerotherapy causes hardening of tissue treatment and regeneration injection for curing.In nineteen fifties, George doctor Hackett, a common surgeon, the theory of foundation is that chronic flesh skeleton pain usually causes (Hackett GS.Ligament and Tendon RelaxaionTreatment by Prolotherapy.3 by lax ligament and tendon ^RdEd.Springfield, III:CharlesC.Thomas Publishers; 1958:1-151).Hackett is expelled in the tissue glucose solution to cause the fibroblast reaction, causes scar tissue formation and ligament and tendon to strengthen.Hackett should treat the called after prolotherapy, was derived from the Latin word, and the meaning is a hypertrophy.After its first description, prolotherapy is used to treat various flesh bone condition, excessively bends and stretches headache comprising osteoarthritis, backache, cervicodynia, fibroplasia and cervical vertebra.Various sclerosis or hypertrophy solution are used in the hypertrophy treatment injection, comprise hypertonic glucose (D glucose), sodium morrhuate, and phenol.Injection is placed on pathological changes tendon or ligament-synosteosis place ideally and avoids direct ligament injection, and reason is that this may cause ligament to destroy and breaks.Modal side effect is pain (the Kim SR in the injection site, people Critical review of prolotherapy for osteoarthritis such as Stitik TP, lowback pain, and other musculoskeletal conditions:A psychiatricperspective.Am J Phys Med Rehabil 2004; 83:379-389).Case report and case book series have reported with the prolotherapy treatment to suffer from the patient's of chronic headache and cervicodynia progress, but lack enough control groups for comparing (Abraham I.Prolotherapy forchronic headache.headache 1997; 37:256).Checked effectiveness (the Kim SR of prolotherapy treatment chronic back pain in many patient's cases of standard care failure at random with semirandom controlled experiment, people Critical review of prolotherapyfor osteoarthritis such as Stitik TP, low back pain, and other musculoskeletalconditions:A psychiatric perspective.Am J Phys Med Rehabil2004; 83:379-389.Yelland M, people Prolotherapyinjection such as Glasziou P, saline injectoins, and exercised for chroniclow-back pain:a randomized trial.spine 2003; 29:9-16.YellandM, people Prolotherapy injections for chronic low-backpain.Cochrane Database Syst Rev 2004 such as Mar C; 2:CD004059).Although research has showed some benefits that prolotherapy is used for backache, because the clinical difference data in studying can not be used for follow-up analysis; Result of study is lacked enough control and exists to interfere mutually obscures (Kim SR, people Critical review of prolotherapyfor osteoarthritis such as Stitik TP, low back pain, and other musculoskeletalconditions:A psychiatric perspective.Am J Phys Med Rehabil2004; 83:379-389.Yelland M, people Prolotherapy injectionsfor chronic low-back pain.Cochrane Database Syst Rev2004 such as Mar C; 2:CD004059).Although research range is little, prolotherapy has shown certain chance of success (Reeves KD in the osteoarthritis with 10% dextrose injection for curing thumb and finger, Hassanein K:Randomized, prospective, placebo-controlled double-blind study of destroseprolotherapy for osteoarthritic thumb and finger (DIP, PIP, andtrapeziometacarpal) joints:Evidence of clinical efficacy.JAltern Complement Med 2000; 6:311-20).

The routine of prolotherapy sclerosis or hypertrophy solution uses catalogue to comprise glucose, sodium morrhuate, and phenol.Such chemicals can be considered to cause the controlled damage of fibroblast/collagen reaction to the influence of people's tissue.Yet, but be accordant to reason is to have corrosivity, zest or toxic other solution when some dependent doses or the higher concentration and also can be advantageously used in the prolotherapy animal tissue is nontoxic relatively when low concentration, described solution can comprise but should not be limited to other sugar juices, polidocanol, salt (being NaCl), dodecyl sodium sulfate.Such solution is injected in the capsule bag between the operation plane that the minimally invasive surgery device produces.Tissue stimulation that chemistry causes or damage will form in described zone, thereby start the reaction of local fibroblast, produce collagen and periplast, fibroblast proliferation and cause tissue tension and regenerate.Aforementioned agents is a solution, yet comprises that the use of the non-solution of micelle, foam and suspension or even insoluble mixtures of material can cause similar fibroblast/collagen tissue reaction.Can comprise at fibroblast/collagen reaction moderate stimulation or the non-solution that controllably damages people tissue but should not be limited to silicones/salt water slurry, the collagen suspension, Oil globule/profit suspension, sand, glass, plastic grain, other insoluble particles, soap, ground microorganism, plant or animal matter.The material of these types can cause having little granuloma reaction of collagen/fibroblast proliferation.Certainly all above-mentioned materials can aseptic injection in the capsule bag and during suitable treatment, extract out or discharge any excessive.

Recent decades, plastic surgeon was biology and abiotic, and organic and inorganic net is inserted in the face with the treatment defective and supports, be inserted into other zones for example abdominal part and groin to support and to keep hernia tissue afterwards.Yet the placement of net must have than applicant and the common required much bigger surgical openings of pending application, and applicant and common pending application allow the big surf zone that may not have to implant net uniquely when only by mini-incision so big net being installed.

The present invention can be used to improve the effectiveness and the safety of face wrinkle-smoothing dough-making powder tension, thereby useful in various face-lifting operations.Aforementioned and other targets, feature and advantage of the present invention will become apparent from the following description and drawings.

Description of drawings

Figure 1A is relevant layers and the key structure that has shown skin, comprises epidermis, corium, hair follicle, subdermal vascular plexus, subcutaneous (fat deposit) and fiber adnexa.Also shown the position of action of the present invention with respect to these layers.

Figure 1B is according to the classical textbook of plastic surgeon Baker and Gordon Facial Surgery regenerationReorganization has shown the mode that cylindrical object (being different from the applicant) passes through in the fiber fat deposit under the corium of face, this will cause irregular, carinate passage and wall.

Fig. 1 C is according to the classical textbook of plastic surgeon Baker and Gordon Facial Surgery regenerationReorganization has shown irregular, carinate, the fine and close fiber adnexa that interrelates with passage and wall, described passage and wall by cylindrical object (being different from the applicant) under the corium of face in the fiber fat deposit by producing.

Fig. 1 D has shown that the identical layer of skin is divided into the side view of the quartering, and each 1/4th five equilibrium has shown position that different classes of energize probe and most advanced and sophisticated configuration are passed through and result's view.The applicant is displayed on 1/4th relative five equilibriums for contrast.

Fig. 2 has shown typical otch and insertion point, the manipulation of device and the side direction or the lateral plan of the table nervous pathway position of diving that is used for facial tension and intensifier.

Fig. 3 has shown the insertion point of anatomic passages and the side view of vector.

Fig. 4 has shown typical otch and insertion point that is used for facial tension and intensifier and the front view that looks up of diving table nervous pathway position.

Fig. 5 A is a top view of paying close attention to the device of distal shaft and tip region.

Fig. 5 B is a top view of paying close attention to the relative projection and the tip region of the device in the zone of relative depression.

Fig. 5 C pays close attention to relative projection, caves in and the front view of the tip region of the device of the section of energizing that interrelates relatively.

Fig. 5 D is the front view that shows the tip of various relative projections, comprises various geometries, for example stacked rectangle or the thin rectangle of convergent.

Fig. 5 E pays close attention to the top view of the tip region of the device of depression relatively.The various possible positions (from left to right) that are used for electrosurgery dissolving element with respect to it have also been shown: recessed relative concave interior or flush with relative depression or outwards outstanding from relative depression.

Fig. 5 F is most advanced and sophisticated front view, has shown the basic planar alignment of relative projection and relative depression.The possible embodiment of certain limit occurs in (from left to right) in the rectangular area: complete plane, " barber shop " tip, crooked shape, geometry.Also shown the various physics contact relations of various relative depressions and relative projection, comprised (from left to right): the bottom connects, and the bottom connects, and has the angle to connect.

Fig. 6 A is the top view of the electrosurgery embodiment of most advanced and sophisticated, axle, the handle peace covering weave relative position that changes window/zone.

Fig. 6 B is the amplification plane or the top view of electrosurgery embodiment, and it pays close attention to the parts and the main traverse in plane change in organization window/zone.Also shown the various geometries (from left to right) that are used for conductive tissue degeneration terminal: circular cone, the rib vertebra, circle, geometry, mane, the elasticity mane has the mane of " curling ".

Fig. 7 is the top view of the laser embodiment of most advanced and sophisticated, axle, the handle peace covering weave relative position that changes window/zone.

Fig. 8 is the top view that is used for other forms of energy and substance transfer are changed to tip, axle, handle peace covering weave on the destination organization relative position in window/zone.

The specific embodiment

The present invention can be used to provide quick and accurate face wrinkle-smoothing operation to make tissue injury and remove minimized device by the surgeon.Described device comprises the undermining axle, and described undermining axle can easily be positioned between the anatomical planes in the tissue and move forward to connect fibrous tissue chorista planes and can not form passage or fibre wall by dissolving all.Embodiments of the present invention provide change in organization's energy and/or chemicals basically plane earth be applied to the new tissue surface that produces.Other embodiments provide a kind of axle, and this axle has enough rigidity to allow the user by control near-end control distal tip.Power on the near-end will produce the power on the corresponding far-end.Axle will be not suitable for catheter in blood vessel, and reason is that it will lack and cross required flexible of vascular system.Pick off monitors with feedback organizes numerical example such as temperature, inductance and control electronic installation control change in organization's energy or mobile to be used for best tissue contracts.

Figure 1A has shown the side view of each layer of skin, and described layer comprises epidermis 10, corium 20, hair follicle 30, subdermal vascular plexus 40, subcutaneous (fat deposit) 50 and from corium by the subcutaneous fiber adnexa 60 that extends to darker face structure 70.Facial hypodermic layer preferably is counted as the fiber-fat deposit of its tough and tensile fibre property of expression.Preservation at the most of the time of eighties of last century subdermal vascular plexus allows the surgeon to lift face by hiding ear face wrinkle-smoothing otch on every side, even cuts off the return blood supply of surface skin to lip, nose and neck simultaneously on all paths.This is possible, and reason is to be different from most zones (blood vessel is from the direction supply schedule surface skins perpendicular to the surface there) of health, and most blood supplies of facial upper hind neck blood vessel by subdermal vascular plexus is tangentially delivered.Also can keep blood supply to organize the life-span by controlling equably with the complete of facial flap on being used for from following clump of blood surgeon of the corium of lip, nose and neck even after the irregular damage of tradition expansion operation.Collagen is played an important role in the especially facial structure of whole health with in supporting; This basic structure albumen accounts for 5% of epidermis, accounts for 50% of corium, accounts for the about 20% of hypodermic layer, and this depends on ethnic group, geographical position, age and patient's former damage history.In face, if fat content reduces owing to many factors then subcutaneous collagen percentage ratio can be obviously higher.Many subcutaneous collagens are present in the feltwork barrier film of fat.Also shown from the right side progressive special-purpose most advanced and sophisticated 90 relative projection 80 towards a left side.What can't see in the view is relative depression and the dissolving section (invisible in this view) that comprises tissue, reason be their follow the tracks of with produce the top, mostly corium, uniform formation plane 95, this tissue plane is from most fibers-fat below tissue plane 98 separation.The device that it should be noted that the applicant does not injure following clump of fragile corium by location dissolving section during passing through.The unique geometry at tip gives the surgeon and directly follows the tracks of sensation when installing proper exercise by human or animal's skin, and have distinctive file sound and sensation, the virtual blind operation that this is convenient to that use feeling is only easily grasped and allows device valuably.The level of the bottom of ball top 30 is passed through in dissolving most advanced and sophisticated 80, thereby destroys ball top and cause a high proportion of defeathering.The removal of hair or minimizing are potential favourable in man's beard zone, and particularly those suffer from the man of folliculitis in the beard zone.

Figure 1B is according to the classical textbook of plastic surgeon Baker and Gordon Facial Surgery regeneration(Baker, Thomas and Gordon, Howard; C.V.MosbyCo., St.Louis, Missouri, 1986) reorganization, shown the mode that cylindrical object 90 (being different from the applicant) passes through in the fiber fat deposit 50 under the corium of face.The opening flap 95 by surgery rake tractive that should be noted that mainly is made up of the corium that is attached with some corium clumps.This same way as that cylindrical object passes through will be created in irregular, carinate fiber channel and the wall of seeing among Fig. 1 C.

Fig. 1 C is according to the classical textbook of plastic surgeon Baker and Gordon Facial Surgery regenerationReorganization has shown irregular, carinate, the fine and close fiber adnexa that interrelates with passage 120 and wall 110, described passage and wall by cylindrical object (being different from the applicant) under the corium of face in the fiber fat deposit by producing.The corium lower surface or the top cortex that it should be noted that now the flap 95 that is kept by tweezers will have the irregular carinate pattern of the thickness that is attached to its lower surface.Dissolve irregular ridge on the planar both sides and on three-dimensional, look Stalactitum and the stalagmite that is similar to the cave.Irregular carinate pattern on the downside of corium absorbs the energy that is applied to lower surface.Non-homogeneous energy absorption produces non-homogeneous result; Non-homogeneous result in the face is distortion.Also shown the scope of the incision length of the commonsense method that is used for traditional face wrinkle-smoothing, length is more than 30cm, with exposed fibers passage and wall good view.The surgeon can shear then or cutter is cut described wall and use bore hole interface channel, yet shears and dissecting knife can not be fit to and can not operate safely by the mini-incision position that the applicant uses.Again, only applicant's geometry can be fit to not enlarge by the miniature incision of 1cm otch and separate with interior at 20 minutes, and present experienced plastic surgeon needs big exposure flap to allow correct the demonstration and bigger apparatus cutting.

Fig. 1 D has shown the side view of the identical layer of skin, and described layer comprises epidermis 10, corium 20, hair follicle 30, subdermal vascular plexus 40, subcutaneous (fat) 50 and from corium by the subcutaneous fiber adnexa 60 that extends to darker face structure.The left side of this figure half 1/4th five equilibrium has at a distance shown typical cylindrical most advanced and sophisticatedly 100, observes from the front, and representative is different from applicant's tip geometry.Yet, in fact every other pointed shape comprises doctor-like, single projection, depression from single or non-homogeneous tip, tilt semicircle, spoon shape, the cutter shape, smooth, run into the problem that is similar to cylindrical tip: undesirable passage forms, and has irregular, thick, residual more feltwork wall./ 4th five equilibriums have shown the instant result that the cylindrical tip of observed typical case (non-applicant's geometry) passed through from the front in the middle of the left side of this figure.It should be noted that " Swiss Cheese " shape void effect 120 has the more feltwork septum wall 110 and 130 of separating owing to the hole of passing through to produce.Be different from before moving forward slowly hole, grind, the tunnel, hill path of removal and all hard rocks of splash forms device, there is not technology enough powerful up to now to remove all soft fat in its path fully, say nothing of and remove the fibre diaphragm wall, even liposuction mode (after repeatedly passing through).Even such device is like this, this invasive, over-drastic removal of facial fat has also stayed the surgeon to the patient and has wanted to avoid and manage corrigent situation desperately: the depression outward appearance of skeleton shape.The wrinkle of heaving in the face is just filled fat and has greatly been facilitated young appearance.Facial fat causes facial appearance aged from normal position disappearance or decline.Unfriendly, the very little fibrous tissue in the path of current techniques can be removed or be gasified fully, especially fine and close collagen fiber septum wall, and known its constitutes the good part of human face's fat lower floor.Non-applicant's tip geometry apparatus by after fine and close barrier film collagen thereby be compressed into fine and close more, may endergonic collagen fiber septum wall 110.Axially cause highly irregular more feltwork fat wall in the tip geometry of using non-applicant, especially form the ridge 120 that is attached to the corium downside by membranous compression of collagen after the miniature incision position and displacement.In addition, after non-applicant's tip geometry was passed through, passage is collapsed into immediately organized slit 130, and described slit can be along many irregular direction orientations shown in the left side of figure.In the middle right-hand part of Fig. 1 b, progressive towards a left side from the right side is from the right applicant's at a distance corium clump protection dissolving most advanced and sophisticated 140 and spools 150 the relative position that is connected on chorista plane equably and after not staying irregular fibre wall or ridge.Be plane change in organization window/zone 160 on the far-end of axle, it can be contained in various forms of energy designs or the change in organization's chemicals described in applicant and the common unsettled technology and disperse port.It should be noted that the uniformity of the tissue plane that on the right side of figure, forms and lacking of irregular feltwork barrier film compression.The tissue that irregular feltwork barrier film compression will absorb application is brokenly modified energy and brokenly destination organization is exposed to chemical gradient.

Fig. 2 has shown the position and the direction of Wicresoft's facia incision, and described otch is face tension and the intensifier apparatus insertion point 210 by epidermis and corium.Also shown the doublet circle 215 around shallow table nervous pathway, all modern plastic surgeons are avoided described shallow table nervous pathway at large and are also advised anyly energizing the described shallow table nervous pathway of device (comprising the applicant's) undermining during face wrinkle-smoothing.Even in these zones, use the level and smooth non-liposuction sleeve pipe of energizing also in medical literature, to be caused the fragile nervus motorius in these zones is caused temporary transient or permanent injury, thereby cause paralysis by report at length.The part top view of face wrinkle-smoothing device of the present invention has shown how the handle 220 of device is held in the hands 225 of user of device.The axle 230 that has the special use dissolving most advanced and sophisticated 235 of face wrinkle-smoothing device is inserted into by the standard openings in the skin 210 or other correct positions on patient's face.Single dotted line is illustrated in the part of the device of can't see under the skin from view.Bending elongation line 260 expression is applied to the upward force on device and the axle 230, and this power is swelled facial overlapping skin slightly.Device is firmly promoted the plane to carry out its function and to keep undermining forward when being promoted forcefully by the operator.Be plane change in organization window/zone 240 (can't see in the view in this expression) on the upper end far away of axle, various forms of energy and change in organization chemicals allow to emit from described plane change in organization window/zone.Change in organization's energy and or the part of chemicals by the length that is included in energy delivery in pipeline 350 and the exterior tubing and material delivery apparatus and crosses device arrive plane change in organization window/zone.If desired than bigger space, available space in the axle, subsidiary pipeline can be advanced to keep streamline shape along the downside of the device relative with the protuberance skin side.Handle can comprise optional excess sound pressure electric transducer, thereby ultrasonic energy can be given axle and most advanced and sophisticated, thereby is convenient to apparatus by fiber-fatty tissue.

Fig. 3 has shown that the position of Wicresoft's facia incision 210 and the side view and the arrow of direction have shown the vector 300 that facial tension and intensifier 310 planes are passed through.Contraction along the direction of line of vector is useful, and reason is that these are that plastic surgeon is sewed up during traditional face wrinkle-smoothing abreast to reappear the custom line of pull in youth.By using shears and dissecting knife carefully, plastic surgeon makes great efforts to avoid damaging the following clump blood supply of corium to allow to flow to from the blood of lip, nose and neck the tissue of the residue vascular plexus supply of traditional face wrinkle-smoothing flap between the tissue plane separation period.Opposite with cutting around whole ear and temple, owing to applicant's device plans only to pass through from several cutting parts, even bigger blood supply also can obtain to nourish healing skin from following clump of corium after applicant's method.The minimizing of energy delivery is dissolved from the bigger distance of the available blood supply adnexa of residue (by the zone 320 of doublet description) at facial plane.These minimizings minimize remote clump and peripheral organization's damage, so alleviated callus nutrition burden.

Fig. 4 has shown that front view and the arrow upwards seen in typical otch and insertion point 210 have shown the vector 300 that facial tension and intensifier 400 planes are passed through.It should be noted that once more from this view and can see the identical doublet circle 410 that to avoid around the identical shallow table nervous pathway.

Fig. 5 A is the top view of face wrinkle-smoothing device.Most advanced and sophisticated 80 can be a bit larger tham axle 90.Handle 220 solidifies and cuts finger control knob 510 and leads to tip and 520 and lead to change in organization window/zone.Yet it is wide and 1-2mm is thick and can be bigger or slightly little slightly than axle to be preferably 1cm for the facial active tip of standard.A size of/5th to five times of these diameters also can have needs and find purposes.For special work, can use proportional more dingus, axle and the tip of width as 2-4mm such as eyelid.The tip can be that for example buckle mechanism, coupling groove, plastics sonic welded etc. are fixed to the independent component of axle by the whole bag of tricks.Alternatively, the tip can be whole or by the prolongation of the axle of metalloid or material manufacture in this model.The tip also can be by the material structure of non-conductive and low heat conductivity; Such material can be a porcelain, pottery, glass ceramics, plastics, various Teflon

, carbon, graphite, and graphite-glassfiber composite.In addition, the tip can be by suitable insulative materials (for example pottery or glass material, aluminium oxide for example, zirconium oxide: Kyocera Industrial CeramicsCorporation, Elkgrove, support substrate structure Illinois).The encapsulant that is used for ceramic embodiment should have compatible thermal coefficient of expansion and be different from platinum or titanium and aluminium oxide or zirconic fusing point, typically is glass or pottery.The favourable ceramic forsterite that is used for pointed tip configuration, its density are 2.9g/cm ³, flexural strength is 1500/kg/cm ², temperature expansion coefficient is (83+/-5) 10E-7, consists of: 0.8% Al ₂O ₃, 41.7% SiO ₂, 51.5% MgO, 6% BaO.Another the favourable pottery that is used for pointed tip configuration is BK 94-1 (a russian index), and flexural strength is 3200/kg/cm ², consist of: 94.4% Al ₂O ₃, 2.8% SiO ₂, 2.3% MnO ₂, 0.5% Cr ₂O ₃External power control bundle 535 is connected to conducting element or distribution 530 will dissolve element from axially taking the conduction that is installed in the depression down to from the RF electrosurgical energy of Electrosurgical generator.The tip can alternatively partly or entirely be made by concentric lamination or annealed wafer material layer, and described material can comprise plastics, silicon, glass, glass/ceramic or pottery.Alternatively, the tip also can be by metal that covers insulator or conductive material structure.Axle is normally flat, and cross section is rectangle or geometry, perhaps can be driven plain a little.The edge of axle smoothly reduced friction on the skin that enters wound, reason it be the summit that the repetition spoke wheel passes through.Axle can have inside that take fully or hollow by metal or plastics or other materials manufacturing, and described inside can comprise covered wire, electric lead, fluids/gases pumping or suction channel, optical fiber, or insulator.The axle plastics are Teflon for example

Can serve as around the insulator of line or conducting element.The axle of any metal or alloy must comprise enough insulant to prevent harmful discharge or the conduction between inner member and axle or the tip in inside.Axle can alternatively partly or entirely be made by concentric lamination or annealed wafer material layer, and described material can comprise plastics, silicon, glass, glass/ceramic, ceramic carbon.Graphite, graphite-glassfiber composite.Depend on embodiment, will be at the optional conducting element of axle inside from external power/control unit (Valleylab Electrosurgical generator for example, Valleylab, the department of United States Surgical of Norwalk, Connecticut, another department of Tyco Healthcare) electric pulse or RF signal are transmitted to plane change in organization window/zone 540.It should be noted that plane change in organization window/zone mean only be opposite planar and even can have the shape of a part of the shape of representing axle, so the arc slightly in window/zone or stair shape or other geometric modification are possible.Pipeline also comprises device and operates necessary necessary electric control line.In the figure from direct view can't see and be positioned at relative depression groove most proximal end part be conductive tissue dissolving element by the Electrosurgical generator power supply, the terminal that it influences the dissolving of tissue plane and be positioned at conducting element in the propulsion of device.Be used to monitor local by back electrical impedance and heat condition a plurality of impedance transducers or the selectable location of a plurality of heat sensor 550 near the tip far away of axle.Temperature and resistance value are can be on display screen tracked or directly be linked to microprocessor, when near or when surpassing preset value microprocessor can signal to the control electronic installation and be transported to most advanced and sophisticated energy with change.Typical instrument path is a well-known, and for example the thermal sensing critesistor is fed to analogue amplifier, analogue amplifier then be fed to the analog-digital converter that leads to microprocessor.Inside or external ultrasound are measured also can provide information, and described information can be involved in feedback circuit.Also can be activated to transfer energy to the tip and additional heating to be provided and to improve dissolving with the low frequency ultrasound transducer optionally.Flash of light visible light source for example LED can be installed in most advanced and sophisticated going up showing by epithelial flap, thus the position of recognition device.

Fig. 5 B is the top view of the tip region of face wrinkle-smoothing device.Most advanced and sophisticated 80 by non-conductive and material manufacture low heat conductivity, porcelain for example, epoxy resin, pottery, glass-ceramic, plastics, or various Teflon

Alternatively, the tip can be by all or part of insulating metal or conductive material manufacturing.It should be noted that visible relative projection 560 and relative depression 570 from this visual angle.We should define or be limited to the device that the tip has projection and depression for this application and related application, if observe from least one angle three-dimensionally, then can see at least two relative depressions with at least one of relative projection.In order to protect subdermal vascular plexus, projection is normally nonconducting and little heat conduction.Various materials can insert in the concave surface of relative depression, pass through along it, get in touch with it, and are outstanding from it, or further cave in wherein; These materials normally conduct electricity, and we are with its called after conduction dissolving element.Tip in this embodiment has the relative depression with three of four relative projections.Conduction dissolving element 565 is arranged in relative depression.This particular embodiment among Fig. 5 B provides one pole most advanced and sophisticated conducting element.It should be noted that relative oval projections is shaped to resemble the precentrum of commercial jetliner and is convenient to tissue and passes through so that reduce towing and reduce resistance.Yet most advanced and sophisticated shape for lugs can have various geometries, includes but not limited to the thin rectangle of stacked rectangle or convergent (Fig. 5 D 560).Other relative shape for lugs can comprise but should not be limited to spheroid, sphere, the sphere on the cylinder, the sphere on the rib vertebra, the sphere on the circular cone, circular cone, cylinder, pyramid, and polyhedron.No matter select which type of pointed shape, habitual total compound tip width can change between 2mm and 20mm, and most preferably between 8mm and 12mm, and thickness can change between 0.5mm and 4mm, is most preferably 1-2mm.Contiguous most advanced and sophisticated but may to cover in the tip be plane change in organization window/zone 540.In the relative depression at tip is conductive tissue dissolving element 565 (invisible from view in most angles usually), and described dissolving element can have any geometry, comprises thin cylindrical wires.Conduction dissolving element can have plate or plane or line shape and can be by any metal or alloy manufacturing that under working condition, can not melt or send poisonous residue; Optional material can include but not limited to steel, nickel, alloy, palladium, gold, tungsten, copper and platinum.These metals can oxidized thereby prevention electric current and function.The calculating oxidation of conduction dissolving element can be used for plan degenerates, thus an embodiment of device can be cheaply, disposable, nonrecoverable device.Yet planning nonexpondable other embodiments needs most advanced and sophisticated conductive tissue dissolving element protected or scribble material, and described material includes but not limited to Silverglide ^TMNot sticking surgery coating, platinum, palladium, gold and rhodium.The amount that changes protective finish allows to change the embodiment of the degeneration probability that can prolong or shorten the apparatus life-span.Most advanced and sophisticated conduction dissolving componentry can produce by plane or the plate of known method in the manufacturing field from the changes shape that is derived from previous materials, and described method includes but not limited to cutting, punching press, casting, molded, rasion and sand milling.This conduction dissolving element board 565 can be to be attached to the insert of the conducting element in the axle or continuous with the conducting element along all or part of formation of axle.Conducting element or distribution 580 dissolve element from axially taking part down to the conduction that depression interrelates with the RF electrosurgical energy.If optionally finger switch is positioned on the handle then conducting element or distribution can switch to utilize hands by bifurcated; From axle be directed to the conducting element the handle or distribution can be tied up with other leads or energy delivery cable, distribution etc. and as the insulation common distribution leave other sources that proximal handle arrives various generators (comprising Electrosurgical), CPU, laser and is described here.Plate can or form scalloped shaped or be manufactured into the tip depression that slave plate will fit in wherein and stretch out slightly by sharpening.Alternatively, because cutting or electric current can cause influence in contactless distance, therefore conduction dissolving element can be recessed in the relative depression or with it and flush.Adjustable, conduction dissolving element can be realized by Screw or ratchet with respect to the position of relative depression.Most desirably the plate of thickness between 0.01mm and 1mm can be by sharpening to change its number of degrees towards preceding surface.The acutance of plate can increase electricity will be from the efficient of edge process of cutting destination organization.Yet, even dullness is variable or not the correct function of sharpening do not hindered yet, reason is that the electrosurgical cut electric current is non-basically in the distance between cutting common 0 and the 1mm on the conductive edge.To such an extent as to the plate acutance can be disadvantageous aspect determining most advanced and sophisticated dissolving conductor part over oxidation can not be worked effectively, reason be similar dissecting knife cutting can allow apparatus by but when having the electricity cutting electric current, might not cause hemorrhage increase yet.Because the standard operation propulsion at tip of the present invention is exposed to colder tissue fluid temperature relatively, therefore be not taken in the quite long working time in the heat of tip operation electrosurgery histolysis conductor and reach the temperature that will it be offed normal, yet under the condition of relatively " drying " or between the operating period that is prolonging, can be at the second and the 3rd insulating method of the junction between most advanced and sophisticated and the electrosurgery histolysis conductor itself to prevent in the tip fusing and to off normal.For example, can be at the thin ceramic coating of one of percentage below the inch thickness on the surface of all the local epoxy bond except organizing exposed point to electrosurgery dissolving conductor plate, ceramic coating can further pass through Connecticut, the method of the Vitek company of Derby scribbles (but not exclusively) paraffin, Halar

(can near 550 ℃ remollescent monochromatic trifluoro-ethylene), Teflon

(can near 750 ℃ remollescent tetrafluoroethene), FEP (fluorinated ethylene propylene (FEP)), HMWPE (High molecular weight polyethylene) or epoxy resin.Can be arranged to holding in the cutting-edge structure of proper fit then with single ground of this mode or the insulating plate in double ground, and it is less to melt risk after the work that prolongs is discharged.Conduction dissolving element also can have 0.01mm-3mm, the preferred shape of the ordinary lines between 0.1mm and 1mm, and can not scribble or scribble aforementioned materials similar in case oxidation or change is degenerated.Line can be described the same by single ground or double insulate and can have and the described identical electric continuity of plane (plate) form with plate.The preferred electrosurgical current of dissolving element of being used to conduct electricity be one pole " cutting " type and setting and can be in preferred successive mode but can select pulse mode to be transported to the most advanced and sophisticated conductor that dissolves equally.The surgeon can control or control by the button control (towards preceding button) on the axle appearance of electric current by the foot switch of Electrosurgical generator.The cutting current amount can be regulated by standard interface on the Electrosurgical generator or graduated disc.Most advanced and sophisticated electric current can be further by by standards body as known in the art certain some interpolation gating circuit of Electrosurgical generator outside with preferred each second 1 time to each second 60 times speed pulse with rate of change.For majority combination embodiment, conduction dissolving element is the one pole tip that contacts with conducting element in the axle, outside operation cable is led at described one pole tip, described cable leads to Electrosurgical generator, ground connection or dispersion plate stretch out from described generator, described plate will be placed on the other places with patient's contact skin, preferred thigh.Such circuit is from the controlled and gating/wiring of cutting current induction system of Electrosurgical generator.Acceptable Valleylab Electrosurgical generator comprises ValleyLab Force 1B, its maximum P-P voltage when " cutting " is 2400, nominal load is 300 ohm, peak power is 200 watts, maximum P-P voltage is 5000 when " solidifying ", nominal load is 300 ohm, and peak power is 75 watts; ValleyLab Force 4 maximum P-P voltage when " cutting " is 2500, nominal load is 300 ohm, peak power is 300 watts, sinusoidal wave form is output as 750kHz, maximum P-P voltage is 9000 when " solidifying ", nominal load is 300 ohm, and peak power is 120 watts, uses the 750kHz decay sinusoidal frequency that has the 31kHz repetition rate.The tip also can be by the multi-layer crystal chip substrate manufacturing that comprises bonding conducting strip and pottery; Conductive material comprises the material that is used for most advanced and sophisticated manufacturing that those have been described.Some most advanced and sophisticated embodiments have shown the depression that flushes with projection when only from top view, but get obviously in some other subtense angle mutations.In the alternative, conduction dissolving element can or be separated into even number at depression bifurcated relatively, is insulated and by be wired to the bipolar outlet that even lead is energized and is connected to aforementioned Electrosurgical generator with bipolar fashion.The ring that partially or completely centers on the axle of handheld unit can be linked at pairing bipolar electrode most advanced and sophisticated or on change in organization window/zone.Bipolar form like this will reduce available horsepower and modify some tissue, especially the thickest tissue with electricity.

Fig. 5 C is the front view at the tip of face wrinkle-smoothing device.The tip has sees oval-shaped four projections 560 and sees it being three depressions 570 of fine rule now that described depression comprises the conducting element 565 of taking one's seat now.It should be noted that the projection of the relative elliptical shape of seeing from this angle.About being used to describe ball and dissolving, projection and relative depression relatively, the term of protection and exposure, in this application and pending application jointly: relative projection is exposed usually and is the shape and spheric of popping one's head in; Depression is the protection zone and can dissolves tissue relatively.We will to show from least one visual angle relative projection or relatively depression with any design category of the description of represent projection or depression and suitable this device.Most advanced and sophisticated shape for lugs can comprise various geometries, especially be convenient to apparatus smoothly by and keep those geometries from the enough spacings of hard skin corium.In the alternative, tip or distal shaft be by the metal manufacturing, described metal except one or more relative depressions and except from the contact point of the lead of energy source have a few by electric insulation; This allows electrosurgical energy to pass through at the dissolving section of energizing.

Fig. 5 D is the most advanced and sophisticated front view that shows the different shape of relative projection 560, and described shape includes but not limited to various circles or geometry, for example ellipse, stacked rectangle or the thin rectangle of convergent.

With reference now to Fig. 5 E,, alternatively, because cutting or electric current can cause influence in contactless distance, therefore conduction dissolving element (dotted line is represented to be difficult to observe) can be recessed into 571 and flush 572 in relative depression 570 or with it.Difference between the depression can change between 0.001mm-10mm with respect to relative projection on the degree of depth relatively when from top view.In order more also to have shown conduction dissolving element from relative depression outstanding slightly 573.

Fig. 5 F has shown that the aligning of relative projection and relative depression is planar basically, thus can comprise fully planar 580 or those have some radians or curvature 581 or even the geometry 583 in the indicated basic planar range of dashed rectangle 584.Also shown most advanced and sophisticated " barber shop " embodiment 582, wherein rectangle becomes infinite thin on the direction perpendicular to the line of the axis of the end by projection.Additional embodiment comprise but without wishing to be held to wherein relatively the plane of depression be not positioned at those embodiments on the plane at the horizontal center by relative projection.But the plane of caving in relatively can be positioned at respect to horizontal plane by relative projection certain other extreme point place or under 582.The location that changes will influence the dissolved degree of depth and intra-operative and postoperative amount of bleeding and the damage of corium clump.In several embodiments, a plurality of protruding members can limit first plane and further limit second plane on a side of the dissolving mechanism relative with first plane on a side of dissolving mechanism; Dissolving mechanism is fixed on and is arranged essentially parallel to first plane and second plane and the position in the scope of extending from first plane and second plane; Device is configured to cut two relatively and planar substantially tissue plane, when device is pushed through described tissue plane and first plane and second plane parallel when organizing.

Fig. 6 A is tip 80, axle 90, the inside schematic top view of handle 220 of the electrosurgery embodiment in plane change in organization window/zone 160.The wire harness that comprises conducting element 610 leads to the switch that is connected to " cutting " (cutting current) control knob 510, and described then button leads to the most advanced and sophisticated insert of being made up of conduction dissolving element at least of dissolving.Wire harness also comprises other leads by handle and axle and optional most advanced and sophisticated heat single, in groups or array and impedance transducer.The output device that inserts along the lead that is connected to pick off is positioned at the somewhere of handle outer and can shows Celsius temperature or draw feedback control by CPU.Other pick offs for example impedance transducer can be read (ohm) along similar path and with feedback suppression.For microwave radio or monopolar radio frequency electrosurgery window/regional embodiment, also the wire harness 620 by the axle outside is conducting element (if it leads to the gauge tap that is connected to " solidifying " (coagulating current) control knob 520 then its bifurcated alternatively), and this conducting element finally leads to the energy element in plane change in organization window/zone.The foot switch control or the vice activation control that are used for plane change in organization window/zone will be easily, and reason is the startup that manipulate surgical doctor's hands can carry out device motion and electrosurgery histolysis conductor.

Fig. 6 B is the amplification view or the top view of the tip 80 and the electrosurgery embodiment in the plane change in organization window/zone 160 of vicinity.Be dispersed in around the described zone is one or more conductive tissue degeneration terminals 630.The terminal between having 6 to 20 preferably.Described conductive tissue degeneration terminal can spread all over plane change in organization window/zone randomly maybe can be arranged to pattern.Described conductive tissue degeneration terminal can form different shape and have the insulation degree of variation at the different aspect of their geometries, number 1 between thousands of.Be shaped as pointed cone 630 in conductive tissue degeneration terminal described in the preferred implementation, their base portion embeds or immerses oneself in plane change in organization window/zone.Other geometry embodiments include but not limited to cube, pyramid, hemispherical, have the spherical and cylindrical of cylinder join domain.Insulator can be arranged to cover terminal contact surface 0 and 100% between." ladybug " is the cheese terminal embodiment that is coated with the insulator in the hole that comprises numerous＜0.1mm.Other the 3rd shapes can include but not limited to mane shape, the mane shape 640 on the near-end spring shape distal tip on straight mane shape, crooked mane shape, the circular cone top and have further bifurcated or the mane shape of " curling ".Conductive tissue degeneration terminal can be by any electric conductor or any metal or alloy manufacturing that can not melt or send poisonous residue in operating temperature; Preferred material can include but not limited to steel, nickel, gold, tungsten, copper, alloy and platinum.Various metals can oxidized thereby prevention electric current and function.The calculating oxidation of conduction dissolving element can be used for plan degenerates, thus an embodiment of device can be cheaply, disposable, nonrecoverable device.Yet planning nonexpondable other embodiments needs described terminal protected or scribble material, and described material includes but not limited to Silverglide ^TMNot sticking surgery coating, platinum, palladium, gold and rhodium.The amount that changes protective finish on the terminal allows to change the embodiment that can prolong or shorten the degree of degeneration in apparatus life-span.Plane change in organization window/zone and conductive tissue degeneration terminal can use annealing technology as known in the art to form the multi-layer crystal chip substrate, and described wafer substrates is made up of bonding conducting strip, pottery, plastics, silicon, glass, glass/ceramic and material.Carbon, graphite and graphite-glassfiber composite also are potentially usefuls.Described plane change in organization window/zone (it is conductive tissue degeneration terminal fixedly) can be to the material structure of small part by non-conductive and low heat conductivity; Such material can include but not limited to: porcelain, pottery, glass ceramics, plastics, various Teflon

The such material of other that mention here.The multi-layer ceramics electrode also can be from OR, and the VisPro company of Beaverton is purchased.In addition, described plane change in organization window/zone can be by suitable insulation material (for example pottery or glass material, aluminium oxide for example, zirconium oxide: Kyocera Industrial Ceramics Corporation, Elkgrove, support substrate structure Illinois).The encapsulant that is used for ceramic embodiment should have compatible thermal coefficient of expansion and be different from platinum or titanium and aluminium oxide or zirconic fusing point, typically is glass or pottery.The favourable ceramic forsterite that is used to construct, its density are 2.9g/cm ³, flexural strength is 1500/kg/cm ², temperature expansion coefficient is (83+/-5) 10E-7, consists of: 0.8% Al ₂O ₃, 41.7% SiO ₂, 51.5% MgO, 6% BaO.The favourable pottery of another that is used to construct is BK 94-1 (a russian index), and flexural strength is 3200/kg/cm ², consist of: 94.4% Al ₂O ₃, 2.8% SiO ₂, 2.3% MnO ₂, 0.5% Cr ₂O ₃Depend on life expectancy and energy from terminal by to produce electromotive force near the temperature of the softening point of the such packing of tetrafluoroethene for example, need terminal and can remollescent material between the second and the 3rd insulating method of junction off normal preventing.For example, can be at the thin ceramic coating of one of percentage below the inch thickness at the lower surface of all the local epoxy bond except conducting element or distribution contact point to terminal; Ceramic coating can further scribble such as paraffin Halar

, Teflon

, the material that FEP or epoxy resin are such.Can sit in the window/zone of previous materials then with single ground of this mode or the insulating terminal in double ground.Conducting element or distribution 650 take the RF electrosurgical energy to be installed in plane change in organization window/zone conductive tissue degeneration terminal under axially.The heating that is derived from the high-frequency electrical pressure reduction that is present between electrode and the earth plate causes peripheral organization, especially comprises temporary transient and permanent contraction of the tissue of fiber.Desired result must not make whole necrocytosiss, and only partial denaturation can cause tension.This embodiment from the current source of Electrosurgical generator normally one pole " solidify " or solidify pattern, thereby need earth plate to be applied to remote location on the patient skin, yet the ideal Electrosurgical generator electric current that is used for other embodiments can be positioned on the scope that " mixing " be provided with or greater than pure cutting " cutting " and is provided with.The surgeon can be by Electrosurgical generator foot switch control or control the appearance of electric current and the level of cutting current can be regulated by standard interface on the Electrosurgical generator or graduated disc by the button control on the axle.Window/regional electric current can be further by by standards body as known in the art at certain some interpolation gating circuit of Electrosurgical generator outside to include but not limited to that each second 1 time to each second, 200 times speed was pulsed with higher rate.This embodiment of pulse will to destination organization stay damage in a organized way or pattern at random (many speckles), and preferred select to provide damage field (crack) under the clinical unrecognizable small surface thus cause pulsating speed and the energy level that adjacent tissue shrinks in a satisfactory manner.In alternative one pole embodiment, can use technical standard grouping in the electrical engineering or separation and wiring to excite thereby be installed in conductive tissue degeneration terminal in plane change in organization window/zone, perhaps make non-homogeneous or many speckle patterns or the many speckles disorganization that electrosurgery change in organization is provided that excite of when apparatus moves described terminal in such a way with random pattern.In the alternative, the conductive tissue degeneration terminal that is installed in plane change in organization window/zone can be grouped and separate or be separated into even number, is insulated and by be wired to the bipolar outlet that even lead is energized and is connected to aforementioned Electrosurgical generator with bipolar fashion from relative electron pair.Another alternative bipolar embodiment comprises one or more beckets and one or more conductive tissue degeneration terminals of serving as first electrode in couples around as returning or the axle placement of second electrode.Compare with the one pole form, so bipolar form is more weak and lack enough power incoming call and modify the thickest tissue.When manage accurately below " scorching fat " with obtain overlapping contraction of skin initial plane form by after manage to energize when apparatus overturn or during the degeneration subcutaneous layer of fat energy availability can more be a problem.Damage subcutaneous tissue or " scorching fat " cause the hypodermic layer inflammation, and inflammation is transferred to the corium flap that covers above and caused corium inflammation and thereby contraction (announce, prepare manuscript to submit to medical journal).Similarly, muscle injury (in this case for coating the platysma of most of foreneck) with cause burning or other fragments can platysma and above cause similar contractile response in the corium flap that covers.The formation of carbon and carbonization organic chemistry (material) may cause inflammation by several paths, comprising: bring and must engulf with the leakage of the macrophage of digesting material and the cell media by the cell aggregation that causes inflammation and cause their organize cascade and tissue to modify.Alternatively, a plurality of positions that a plurality of basic plane change in organization window/zone can be on axle, however more the position of near-end will can " not seen " and the destination organization surf zone of energizing of far-end as much, reason is that handle can not enter otch.In addition, those a plurality of possible positions on the axle in basic plane change in organization window/zone comprise window/zone are placed on the bottom or opposite side of custom use.The zone can be on the both sides of axle to be used for energy or material shifts simultaneously.

Fig. 6 A has also described the axle that is connected to monopolar radio frequency electrosurgery plane change in organization window/regional embodiment and the typical operating room of handle 220 is equipped.By wire harness be the lead 621 that leads to switch 520, described switch is connected to " solidifying " (coagulating current) control knob, described button further leads to the energy element in plane change in organization window/zone.Described circuit derives from " solidifying " control and the delivery port of Valleylab Surgistat of high frequency Electrosurgical generator-for example or Force 1.Comprise the conducting element 610 that leads to switch from independent or similar Electrosurgical generator wire harness, described switch is connected to " cutting " (cutting current) control knob 510, and described button further leads to conduction dissolving element.Use disposable ground connection colloid plate the patient to be grounding to machine as dispersive electrode 625.The skin type that depends on the patient might only use to be applied to the electric current that clump is protected the electrosurgery histolysis conductor of most advanced and sophisticated and connection, and the surgeon can electricly modify dermal tissue and arrive acceptable tension of face-lifting and the enhanced degree of taking place.Thereby, (thin skin skin in some cases, age, heredity etc.) may not necessarily use energy from any kind in plane change in organization window/zone, if can cause enough significant tissue contracts, damage and change from the simple energy of cutting tip.Although plane change in organization window/zone is placed on the supine side of axle plan traditionally, independently plane change in organization window/zone can be positioned on the opposite sides of the axle that uses any type of window/zone of sending the energy described in this application or the related application.

Fig. 7 is the big and relevant electromagnetism light (laser) of microfissure/incoherent electromagnetism (light) plane change in organization window/regional embodiment amplification view or the top view that is present in the apparatus identical with handle 220 with aforesaid tip 80, axle 90.In axle by with contiguous or to be formed in the external beam be a plurality of or single fiber optic component 720 that leads to plane change in organization window/zone 730.Energy by optical fiber is controlled by foot switch in electromagnetic energy source.In one embodiment, plane change in organization window/zone is an optical window 730, and it allows laser to leave axle and near the destination organization of irradiation.The light conveying appliance that can be hollow waveguide or single or multiple optical fiber (metal coating plastics for example, it is by Phoenix, the Polymicro Technologies company limited of Az is made) is included in the external pipe 710.External pipe also can be the articulated jib that is used in usually in the surgical laser system.Additional control line and power can be transported to head by external pipe.Yet the surgeon uses from the foot switch control of electromagnetic energy radiation source or control interface, graduated disc or panel hell to pay and reduced the expense that the control of head finger is made not.May allow laser leave by the optional window 730 of germanium manufacturing and collect data, can have varying dimensions by heat sensor 550.In another embodiment, composite fiber can stop by the specific or random site in plane change in organization window/zone.Naked or coated optical fiber terminal like this can be given prominence to, flush with it or be recessed into wherein from the material that comprises plane change in organization window/zone.The sterilizable bare fibre of ethylene oxide,1,2-epoxyethane can be preferably be arranged in hot non-conductive background with an angle of 90 degrees of unanimity, but the variable angle between 0 and 180 degree also is effective.Preferred light conveying appliance depends on the Wavelength of Laser of use.The infrared light that heat tissue sends also can by window collect and by the Infrared Detectors sensing to measure tissue temperature.For CO ₂Lasing fluorescence, the source comprises the standard procedures chamber unit reliably, for example from Santa Clara, the Encore Ultrapulse of the Lumenis company of California

, it can provide the 2-22 milli burnt continuous CO at the 1-60 watt ₂Laser energy output, Coherent Ultrapulse's is suitable (Coherent owns for Lumenis now) than old model.The hollow space of axle can serve as waveguide maybe can comprise metal coating plastic optical fiber or waveguide with allow laser by with leave near most advanced and sophisticated window.The laser that window allows to be transported to device leaves.Available laser in the present invention comprises pulsation and continuous wave laser, for example CO ₂, erbium YAG, Nd:YAG and Yf:YAG.Those skilled in the art can change beam diameter with standard mode.Yet this is enumerated not is to want self to limit and can use the laser of other wavelength.Relevant or noncoherent radiation can be transferred (apparent wavelength's situation is decided) from their source and enter head and further by waveguide and mirror or end at the optical fiber of mirror or integrally portion, the optical fiber that flushes or end in its outside the material that comprises plane change in organization window/zone with it are directed into plane change in organization window/zone within it by articulated jib or optical fiber.An embodiment that produces the bigger shape zone, big crack of destination organization degeneration is with as CO ₂Such laser energy split into a plurality of littler optical fiber of diameter range at 0.1mm-1mm, CO ₂Laser has Phoenix, the optical fiber that the PolymicroTechnologies company limited of Az is made.Thereby described optical fiber can axially or at contiguous certain angle termination laser energy that radiation is directed to the mirror in plane change in organization window/zone be dispersed into the destination organization from window.Described optical fiber can from the base material that comprises plane change in organization window/zone saliently, flush ground with it or recessedly wherein stop.Described window/zone can with the remainder homogenizing of axle or similar or use those similar methods of the electrosurgery embodiment description be similar to plane change in organization window/zone that it is annealed on material.More low-melting plastics also can be suitable for described optical fiber is fixed in plane change in organization window/zone.But be similar to still less bigger optical fiber about those about 1mm of Polymicro Technologies manufacturing and can be used for bigger zone in the controlled local necrosis of middle and bottom corium generation destination organization.Have and make the vascular supply avoid the clinical visible cicatrix that the destructive ideal dimensions of inserting the disorganization below 1mm in zone has helped to have avoided to change the junction of tissue and reduced to see in close-ups or sociodistance.Suppose plane change in organization window/zone 1cm/sec that in destination organization, travels forward, then have three or above fibre-optic terminus (preferred array comprises the fibre-optic terminus of 10 larger diameters) but scope be that the laser pulse frequency of 1-1000 pulse/sec will cause clinical accept enough little destination organization controlled to focus on downright bad regional area.Excessively the radiation of intensive non-pulsation Electromagnetic Continuous can be in unbroken mode to organizing cut, thereby isolate bigger tissue regions near fresh oxygenated blood fluid.Not too intensive non-pulsation electromagnetic radiation can cause some cellular contraction reactions and not destroy blood vessel.For can being equipped with the mirror in adjacent plane change in organization window/zone, the microfissure head of conveying capacity integrally makes as lasing light emitter (the Reliant MTZ that is fit to ^TMSR Laser, Reliant Technologies, Palo Alto, when CA) on its focal length, being changed and being installed to the near-end of handle of embodiment, at random or figuratum laser can be along head and axially be sent on the mirror and outside the window in plane change in organization window/zone down and be redirected on the destination organization.Can exist to be used for the inner scope of using that is provided with, however preferred those the 1.5 microns 32J/cm that surpass applications that are provided with ²Unit.Because bottom corium and the subcutaneous thickness that is connected, will need bigger energy when from inside to outside launching laser when producing towards the downright bad fragment of the intradermal microcosmic of last corium, avoid destroying epidermis simultaneously.Being similar to described those tissue impedance and the thermal surveillance device of electrosurgery window can be used in combination with laser energy window/regional device.

Fig. 8 leads to the inside schematic top view that various forms of energy delivery can be arrived handle 220, axle 90 and the tip 80 in the plane change in organization window/zone 730 of destination organization.Along handle and axle be optical fiber, distribution, conducting element, the evacuation piping, insulating gas or FLUID TRANSPORTATION piping monitor and to lead and any other control is connected with supervision.Optionally heat and impedance transducer may reside in spool or the tip among or on.Being used for pulsing luminous plane change in organization window/regional embodiment strongly can be as common pending application and following being configured.Incoherent, non-laser, optical filtering flash lamp send the visible light in broadband in strong pulsation.For example by ESC/Sharplan, Norwood, flash lamp (the 500-1200nm transmitting boundary of the less form that Massachusetts uses; 50J/cm ²Lumen; The 4ms pulse; The 550nm filter) can take the handle or the window/zone of embodiment.The IPL flash lamp holds can obviously increase axial thickness, 1cm enter otch can along separate hatching line easily be deformed into 1.5cm otch and with the combination of the vertical incision of 1-1.5cm to form little A-P flap, the axle of larger diameter can enter and sew up easily from described flap.Flash lamp sends the light and heat radiation, thereby described radiation can directly be left plane change in organization window/zone or be reflected and leaves reflector and also leave by window.Reflector can have parabolic shape to collect all radiation of launching from window effectively, and described window can be made by the various glass (for example quartzy, fused silica and germanium) of transmission light, near-infrared and infrared light.Emission spectra can be filtered with the effect of realizing ideal.Heat emission or absorption of visible radiation can heat corium partly to change collagen; Heat sensor control reduces superheated.In order to eliminate the axle and the superheated of facial tissue on every side, flash lamp and reflector can be pumped by the hollow of axle or handle by low Heat Conduction Material heat insulation or cold nitrogen.Thereby handle can pass through window/zone by specularly reflected in the alternate position emitted radiation.The plane change in organization window/regional embodiment that is used for the frequency microwave emission also can be configured as common pending application; Can or be connected to the pottery of plastics or polymer or ceramic tip are partly made by metal or plastics at such embodiment axis, it has and adheres to or be exposed to plane or opposite planar or add up to even phased array antenna on the curved side slightly.The phased array of antenna is made by metal (being preferably rustless steel, aluminum, gold, steel, or platinum).Phased array can be worked in the scope of 1-10 gigahertz, produces the power up to 20 watts, and penetration depth is 1-3mm.The plastics of the about 0.01cm-1cm of cryotherapy embodiment utilization in plane change in organization window/zone 730 or thermal resistance pipe or tubule 740 come to carry the cold therapy agent by inertia or insulation piping 810.In the cryotherapy embodiment, cold inertness gas or liquid for example nitrogen (196 ℃) are suitable for an embodiment and are kept at outside and low-temperature (low temperature) vessel or the reservoir near gate there that is arranged in axle.The cold therapy agent is not in freezing (between storage life) but changes between frost free period, changes, destroys or the modification destination organization, the heat energy that is derived from inside and outside people's environment between frost free period on every side heats the destination organization that thaws now, thereby cause infringement, include but not limited to the cell implosion of organelle, the cell membrane dissolving, crystallization, and species precipitate.The other benefit of nitrogen is stability and stops near operation electrosurgery or calutron burning.The cooling capacity of density and liquid nitrogen more approximately is 1,000 times of nitrogen.More be not difficult to be transported to window having to be in its liquid nitrogen under the situation of significant insulation thickness from container.So the fluidic mixture of gas and gas and main air inclusion keeps head size easily simultaneously with easier control.When cold therapy, can discharge by the heat sensor feedback loop with the cold nitrogen that sends the 1cc that speed passes through of 1cc/0.1sec-10sec and coordinate to depend on that destination organization temperature and density change destination organization more accurately in " window " temperature of from-196 to-30 ℃ of variations.The gas that is vaporizated into enough volumes is entered the release gas in the relative closure chamber of dissolving between the tissue plane or the fluid face that can expand, thereby must use evacuation piping or pipeline to discharge gas buildup and pressure 750.The foot switch control or the vice activation control (adding optional heat sensor/CPU feedback loop) of release of fluid will be easily, and reason is the startup that manipulate surgical doctor's hands can carry out device motion or dissolving function.

Vibrational energy can be given the hydrone that comprises through near the destination organization the piezoelectricity in the change in organization window/zone of direct piezoelectricity form.Temperature rises and causes collagen to change and cell wall destruction, yet the ultrasonic energy application can have the effect of breaking at subcellsular level equally.The crystal that obtains electric charge when being compressed, twisting or being out of shape is piezoelectrics.The electric oscillation that is applied to some ceramic wafers causes ultrasonic mechanical vibration.The energy output that is used for piezoelectricity window/zone should change at 1-30J, and preferable range is 1-6J in the surgical device that about 1cm/sec moves.As every other embodiment, provide the temperature of intra-operative real time data and impedance transducer can regulate the energy that is input to piezoelectrics, described piezoelectrics by further with control unit be connected with power supply the axle in conducting element energize.In another embodiment, hot gas or fluid or their combination can be injected on the destination organization from window/zone.For example, collagen is 70 ℃ of degeneration and cause cytoclasis, and steam or hot water can be carried to leave window/zone by various mechanisms and arrive on the destination organization.Steam under the pressure can be by insulating, high pressure the thermal resistance pipeline be transferred from the auxiliary water heater of axle or handle outer.Pipeline can be separated into one or more tubules before being transported to destination organization; Suction chamber can be removed owing to the gas in the space of relative closure sends any excess pressure that forms.Alternatively, steam can be produced by the small single piezoelectrics that are arranged in window/zone.In this embodiment, little tubule is carried the fluid that can be vaporized in the temperature range that little piezoelectrics work, such piezoelectrics are used for coating at present and printing ink use (MicroFab TechInc, Royal Cox, Plano, Texas).Water is transported to piezoelectrics and prevents drawback movement by unidirectional microfluidic flow valve system.The piezoelectrics of number between 1 and 1,000 can be installed in window/zone with array format, and the microfluidic flow valve prevents the drawback movement of water in the water precipitation running system.Randomly or nonrandom ground, can controllably make various piezoelectrics give hydrone to produce local vapor region with vibrational energy.Steam can with many speckles or uniformly mode from Teflon

Or similar piping ejection is with the tissue on the both sides of modifying or damage facial anatomical planes.

The prolotherapy embodiment in plane change in organization window/zone hypertonic glucose (D glucose), sodium morrhuate and phenol are provided and are in liquid state, foam, suspension, powder or any other form other cause that Fibrotic chemicals or mixture (include but not limited to concentrate saline solution, acid, alkali, cleaning agent, NaTDC, polidocanol, dodecyl sodium sulfate, and hypertonic saline) instillation, above-mentioned substance can controllably damaged tissue or stimulation fibroblast or increase collagenzation in the chamber of the tissue plane that dissolution of the present invention forms.Then they can be by their opposite counter pair neutralization to cause fibrosis to be used for intentionally damaged tissue as fruit acid or alkali, and for example acid solution causes the sodium bicarbonate lavation neutralization of damage by dilution.Can comprise at fibroblast/collagen reaction moderate stimulation or the non-solution that controllably damages people tissue but should not be limited to silicones/salt water slurry, the collagen suspension, Oil globule/oil suspension, sand, glass, carbon and carbonization organic substance, plastic grain, other insoluble particles, soap, ground microorganism, plant or animal matter.Such material will cause having little granuloma reaction of collagen/fibroblast proliferation.Approximately the plastics of 0.01cm-1cm or pressure-bearing pipe or tubule can send embodiment by the prolotherapy that inertia or insulation piping are transported to plane change in organization window/zone with the hypertrophy therapeutic agent.Described in other embodiments tubule can end in the small nozzle to allow hypertrophy therapeutic agent spray distribution to destination organization.In the prolotherapy embodiment, hypertrophy therapeutic agent or other change in organization's medicines be arranged in axle outside and there near I V bag or other reservoirs of gate be ready.Fluid from the gravity of I V bag progressive can be enough I V piping by several meters by axle the hypertrophy therapeutic agent is assigned on " window/zone ".For instiling or spray distribution, the hypertrophy therapeutic agent can be forced on its passage from reservoir by several different methods as known in the art, and described method includes but not limited to peristaltic pump, and gas-pressurized instils, powered, injection system and the reservoir that can pressurize.Flow rate and pressure rate can depend on concentration, volume, desirable tissue contraction time and the types of agents that applies and change and can change at per minute 0.01cc-10cc.The foot switch control or the vice activation control (adding optional heat sensor/CPU feedback loop) of release of fluid will allow convenience, and reason is the startup that manipulate surgical doctor's hands can carry out the dissolving function of device motion or device.

The plane change in organization window/regional embodiment that is used for the even heating element can be by being configured on the side that uniform tissue heating element is attached to proximal tip, described proximal tip is connected to the insulation conducting element by axle, and described heating element heater is controllably switched at handle in the mode that is independent of the radio-frequency (RF) component in the dissolving section.Near heat sensor monitors tissue temperature so that maybe can listen output to surgeon or computer generation feedback, thereby controllably energy distribution is arrived destination organization.This ring thereby can controllably limit hot disorganization and optimize shrink the result.Heat sensor can be an infrared type, fiber type, and electronic type, or optical fluorescence type, every type is known in the prior art, thereby thinks and there is no need to be described in greater detail.

Be used for the plane change in organization window of thermal forming embodiment/zone and allow heat energy to escape from axle is inner, most advanced and sophisticated there can with integrated or its continuity of axle of metalloid or material manufacture.The tip also can be by the material structure of non-conductive and low heat conductivity; Such material can be porcelain, pottery or plastics.Part most advanced and sophisticated and axle can be coated with Teflon So that device smoothly moves under skin.Hot filament in the device by the heating of the streaming current by connecting line and by the strength rigid of line remain in the appropriate location of parabola shaped intracavity.Alternatively, be connected to hot filament fixed axle.Hot filament sends the light and heat radiation, thereby described radiation can directly be left plane change in organization window/zone or be reflected and leaves reflector and also leave by window.Reflector can have parabolic shape to collect all light and heat radiation of launching from window effectively.Hot filament can be to be similar to those the tungsten carbide filament that uses in high power lamp bubble.Wavelength can be regulated and control by regulating filament temperature/electric current.Window can be selected from the various glass (for example quartzy, fused silica and germanium) of transmission light, near-infrared and infrared light.The tissue penetration degree of depth depends on light wavelength (for example 1 μ m penetrates 10mm, and 10 μ m penetrate 0.02mm).Come the wide emission spectra of self-heating filament can be filtered tissue effect to realize ideal.The special emission spectra that filters will cause ideal collagen contraction and tension corium is heated to about 70 ℃ temperature.Optimal spectrum is filtered and is depended on skin thickness and structure.Monitor temperature with the tissue that touches of being coupling by the heat sensor that is wired to control unit.In order to eliminate the axle and the superheated of facial tissue on every side, heating element heater and reflector are by low Heat Conduction Material heat insulation.Element is insulated by engagement shaft not, and reflector can have insulating barrier, and it is connected to axle at described insulating barrier.In addition, cold nitrogen can be injected and is pumped out with cooling tip and axle by quill shaft by pipe.Flowing nitrogen (or another noble gas) by quill shaft has also reduced the oxidative damage to filament.Alternate embodiment in the common pending application is placed on the light and heat radiation of sending simultaneously in the handle with hot filament and is reflected by window and leaves mirror.Alternate embodiment in the common pending application allows to realize the tissue heating by directly contacting with hot surface, and the electric current that flows through line at described hot surface will be heated to the user and select temperature by the ohmic load of single or multiple element manufacturing.Ohmic load can be that thin film resistor and film temperature can be estimated from the resistance of measuring.Alternatively, near the heat of dissociation sensor measurement temperature that heating element heater is placed, described temperature is sent to control unit with the electric current of control by ohmic load.Cold air or fluid can be injected and are pumped out by axle by pipe.And heating element heater can be the hot side of Pa Er card thermoelectric (al) cooler, and it advantageously is cooled to opposed surface below the environment temperature, and temperature difference reaches 40 ℃.The wherein hot hot embodiment that obtains by magnetic or rubbing method can cause similar change in organization.

In all embodiments of device, axle can scribble for example Teflon of bio-compatible non-adhesive material

To reduce the friction that the operating period self-organizing is bonded to device.

The present invention also can be created in clear-cut in people's tissue plane or the position restriction or insulating capsule bag to be used to implant the organic or inorganic implant.For example, applicant and applicant's previous correlation technique is operated the zone generation capsule bag of cheekbone shape and additional desirable appearance below the imitation on ' weak ' cheekbone, and implantable liquid of organic or inorganic or semisolid can be expelled in the described capsule bag.Current implantable material includes but not limited to: can absorb suture material polylactone acid (Vicryl

, Polysorb

), polyglycolic acid (Dexon

), polydioxanone (PDS II

), glycolic (Maxon ), poliglecaprone 25 (Monocryl

), Glycoer 631 (Biosyn

), gutstring (plain), gutstring (chromic), gutstring (fast Absorption).Non-absorption suture material: nylon (Ethilon

, Dermalon

, Nurulon , Surgilon

)-braiding or not the braiding, polypropylene (Prolene

, Surgilene

, Surgipro ), silkworm silk, polyester (Dacron

, Mersilene

, Ethibond ), polybutester (Novafil

), Surgical Stainless steel Graft/net includes but not limited to: expanded ptfe (ePTFE) (Gore-Tex

, SoftForm

), polyethylene (Dacron ), polypropylene (Prolene

, Marlex ), polyglactin 370 (Vicryl

, Dexon ), polyethylene terephthalate (Mersilene

), polypropylene/polyglactin 370 (Vypro

), Alloderm

, Sepramesh

(on a side, scribbling the polypropylene net of hyaluronate sodium and carboxymethyl cellulose), Seprafilm (hyaluronate sodium and carboxymethyl cellulose), silicones, PROCEED

Outer scientific network, ULTRAPRO

Part can absorb the lightweight net, Surgical Titantium Mesh

Hybrid materials include but not limited to: bovine collagen (Zyderm

Collagen I, Zyderm

Collagen I I, Zyplast

), be derived from people's collagen (Deramologen

, Cymetra

), corpse fascia lata (Fascian

), pig collagen, derivatives of hyaluronic acids (Restylane , Hylaform , Hylan B

Collagen, Perlane

), Alloderm

(acellular allograft corium matrix), polyethylene terephthalate (Mersilene

), Proplast

, Medpor , titanium alloy, cobalt molybdenum chromium metal alloy, silicones, hydroxyapatite, bio-vitric and non-ceramic hydroxyapatite.

Plastic surgeon was inserted in the face biology and abiotic, organic and inorganic net with the treatment defective and supported recent decades, be inserted into other zones for example abdominal part and groin to support and to keep hernia tissue afterwards.Yet the placement of net must have than applicant and the common required much bigger surgical openings of pending application, and applicant and common pending application allow the big surf zone that may not have to implant net uniquely when only by mini-incision so big net being installed.Net can be by following material manufacture: the somatic reaction organic substance comprises cotton and silkworm silk; Health inertia organic substance, plastics for example, polypropylene or (Gore-Tex

(low density polyethylene (LDPE)); At intermediary material, the nylon of microresponse for example; Inorganic substances, for example rustless steel or other metals and silicones.Net can launch enter the wound insertion by Wicresoft after or untie to occupy any or all separated tissue plane.Net can be changed extending in upper hind neck, thereby almost extends to ear-lobe to serve as hoist cable when the suture fix in position from ear-lobe.On the other hand, fix to be delayed or to allow to heal in position (or fibrosis=collagen forms) at the fraction of opening the tissue plane that comprises supporting network again with some months net before being used to guide the suture tension.Strainer net can be sewn immediately to produce tension force and/or support.The location of net and correctly take apart can by endoscope or by portable x ray by radiopaque coating be embroidered with metal or element or chemical compound definite.Net can by sandblast, rasion or the sterilization before the chemical modification material be manufactured into " more tacky " to collagen that enters and fibrous tissue.Surgical device also can be used for Wicresoft's mode deposition profile implant " cheekbone " type implant or profile fluid, semisolid or other implants not too clearly for example clearly.Depend on the needs that hang lax or sagging tissue, for example grid, net or the hoist cable of Yi Xia bio-compatible organic or inorganic material can be implanted to be used for sutured or tension immediately.Alternatively, biocompatible material can be allowed to " healing in position " to strengthen the surgical procedures that following tissue is provided with the back or postpones.Potential implantable biology can absorb and not absorbable material below enumerate be not limit and be not to want restriction: polylactone acid (polyglactic acid), polyglycolic acid, polydioxanone, glycolic, poliglecaprone 25, glycoer 631, nylon, polypropylene, silkworm silk, cotton, polyester, polybutester, surgery rustless steel, expanded ptfe (ePTFE), polyethylene, polyglactin 370, polyethylene, terephthalate, Dacron

, Alloderm

, Sepramesh

(on a side, scribbling the polypropylene net of hyaluronate sodium and carboxymethyl cellulose), Seprafilm

(hyaluronate sodium and carboxymethyl cellulose), silicones, PROCEED

Outer scientific network, ULTRAPRO

Part can absorb the lightweight net, Surgical Titantium Mesh

, be derived from the collagen of cattle or people or pig, corpse fascia lata (Fascian

), derivatives of hyaluronic acids, Alloderm

(acellular allograft corium matrix), polyethylene terephthalate (Mersilene

), Proplast

, Medpor , titanium alloy, cobalt molybdenum chromium metal alloy, hydroxyapatite, bio-vitric and non-ceramic hydroxyapatite.For example, Gore-tex

Hoist cable can use typical surgical instruments for example tweezers, hook, clip and fibrous tissue and under neck from right to left between the mastoid region ductile seal wire be connected in series to by miniature incision big below in the dissolving plane, if otch is arranged in the territory, subauricular region.Net in the solution plane facial planes can be untied and handle in place by the probe or the apparatus that are placed in any cutting part in case be fed to by the miniature incision position; Correctly taking one's seat of net can be passed through endoscope, detect by optical fiber with by ultrasonoscopy.If metal marker for example metal wire is interspersed the edge of net then ballistics assessment is possible intermittently, especially self form or when being attached to any radio-opaque material by any radio-opaque material when netting.At little width＜2cm but the net on the roller of thickness＜1cm can be fed to cutting part and accommodate probe, apparatus or extending hook and untie net along change direction to use other cutting parts.Described roller is equipped with by the line of the loose＜6cm at the center of " roller " or slender silk plastic coil.Alternatively, device can with more restricted mode be used with in such zone for example the selected tissue plane level of the surgeon on the cheekbone knuckle (cheekbone) produce accurate, insulating, uniform tissue capsule bag, thereby the standard implant can enter otch by device, expand some with dissecting knife and enter wound or for example be admitted in the oral cavity from certain other position.Can produce accurate capsule bag holding the soft foam that bio-compatible heat is provided with or the time is provided with or reactant is provided with, described soft foam is restricted to the shape of the capsule bag that apparatus produces and can is by exerting pressure during being provided with by finger appearance or template appearance.How after the measure of going up in office, two can be absorbed imbed 5-0 Monocryl

(Ethicon divisionof Johnson ﹠amp; Johnson, Piscataway, New Jersey) suture is placed in each otch.Usually do not need the wrapping and the patient can return work or the rest of being in.Alternatively, if placed significant prolotherapy or implantable material loose silk flosssilk wadding-filament wrapping can be applied in facial around 24-48 hour.If the patient has enlargement or hemorrhage trend, little Jackson-Pratt drainage tube can and be sewed up in place under wrapping by any cutting part placement.

Plan degenerate be integrate with proper property and quality along with the time holding device.Insert in the middle of the section of the circuit of aforementioned embodiments and/or fibre optical device (fiberoptics), along its insertion or insert between it can be for example block or chip on hardware or software.Card or chip or other use and monitor that sub-device can be inserted in the receiving area that resembles in the such place of handle or contiguous Electrosurgical generator; It can record data, include but not limited to service time, cutting current, coagulating current or mixed number.Be inserted into sub-device in circuit, fibre optical device or other energy delivery mechanism and can stop the function of device, restart unless the standard of certain type satisfies.Standard can be to obtain password, neocaine or chip after paying.Current being used for this and other plan quantitative, that monitored or restricted use and can being used in combination of being known in the art with the embodiment that proposes.

Operating process: after notice was agreed and freely eaten and drunk 12 hours, the patient was in supine position and is placed.With cleaning agent before the operation of standard for example iodine tincture or chlorhexidine cleaning face and cervical region.According to surgical judgement before ear or the miniature incision position of any position mark 1cm of rolling off the production line of ear.May going up most in the forehead in hairline come labelling 1cm miniature incision position in order to reach cervical region zone neutralization in (below the chin) district under can comprising chin in order to cover otch with the surgery labelling.Draw with the dotted line of surgery labelling in the zonule of skin that is coated with the zone of dangerous sports nerve (lower jaw edge nerve, the nervus facialis volume props up, spinal accessory nerve).At this moment, the patient selects the dim calmness of intravenous or gives general anesthesia by endotracheal tube or LMA (laryngeal mask airway), although most of patients does not need in these measures any one to restrain oneself remaining process.Surgery labelling cutting part is further cleansed then all only to be injected with 1% lignocaine (having 1: 100,000 epinephrine) of 1cc and allows to leave standstill 3 minutes.Each zone enters hypodermic layer with the #15 scalpel blade by epidermis and corium and makes otch; The forehead position should be parallel to hair follicle and make otch to prevent the baldness in the zone.Prepare 1 liter of Klein swelling solution with following prescription: mix 2% lignocaine of 40cc and the 10mEq/L NaHCO of 10cc in 1 liter of common saline ₃With 1: 1,000 epinephrine.The fluid instillation conduit that uses spinal needle or 2mm wedge shaped tip or spatula tip in the fan shape moving of the vector that is similar to the direction of passing through after will finally being facial take-up device only the Klein swelling solution of 50cc-200cc delivered in the accessible zone of each cutting part by peristaltic pump apace and enter hypodermic layer.After required a few minutes are instiled in Klein swelling, for maximum efficiency Klein solution was allowed to leave standstill 15 minutes.One of selecting arrangement embodiment described here is held aseptic and is connected to one or more Electrosurgical generators or the generator of laser instrument or other form of energy.Before using electrosurgery window/regional embodiment, Electrosurgical generator is set to suitable cutting and solidifies setting.When tightly remaining on handle, will be inserted in one of cutting part and axially powerfully during wrinkle removing takes place promote it by screening device.When installing, along not entering the straight line setting in motion of palpebral region or lip or the motorial scribe area of shallow table usually from cutting part eradiation far away as far as possible with the spoke form by foot switch or handle rocking bar or start button startup.Depend on and organize dissolved quality, patient age, former operation on face history, medical history, physical examination, patient demographics, tissue plane change in organization window/zone can " face up " to start and think that corium is energized or subcutaneous energizing thought in " facing down " startup, this will leak fatty acid and cause inflammation cell and media, then stimulate relative skin corium fibroblast to make collagen; Also can use the combination of " facing up " and " facing down ".Subcutaneous tissue below the damage or " scorching fat " cause the corium inflammation and therefore shrink (do not announce, prepare manuscript to submit to medical journal).Similarly, muscle injury (in this case for coating the platysma of most of foreneck) burns or other fragments causing, can platysma and above cause similar contractile response in the corium flap that covers.The formation of carbon and carbonization organic chemistry (material) may cause inflammation by several paths, comprising: bring and must engulf with the leakage of the macrophage of digesting material and the cell media by the cell aggregation that causes inflammation and cause their organize cascade and tissue to modify.In addition, can occur in the pushing part from the energy applications in plane change in organization window/zone and divide on the withdrawal part of relative stroke.Promote part and can provide or not provide the coldest environment to window/zone, this can change along with the energy level that interrelates with electrosurgery histolysis element.The external refrigeration device can before the treatment, during or be applied to skin of face afterwards, for example, the outside moulding bag that the towel of icy water logging bubble or icy water cycle pass through is with the enhancing reverse thermal gradient.Depend on the many factors that comprise kind of energy and use amount, may need to use prolotherapy solution to carry out the additional dissolution tissue plane and modify that described solution can be by being included in the axle or being injected along the pipeline of axle or by conduit mechanism independently.Resemble the such solution (hypertonic saline) of the 25%NaCl of 250cc can start apparatus by after be instilled between the facial plane of new incision in the space, the massage or allow to sit quietly 10 minutes, be forced out by cutting part then, be used in 2 normal saline neutralizations that flush of instiling in the individual conduits system then, its instillation swelling solution is forced out by identical cutting part then.The hypertrophy therapeutic agent of enhancing tissue fibering as known in the art and person joint's collagenzation comprises sclerosis or hypertrophy solution, hypertonic glucose (D glucose) for example, sodium morrhuate, and phenol.Be in liquid state, foam, suspension, powder or any known the cause Fibrotic chemicals or mixture of other forms of fibroblast or increase collagenzation of can stimulating and (include but not limited to NaTDC, polidocanol, dodecyl sodium sulfate) can be similar to aforesaid 25%NaCl is instiled.Then they can be by their counter pair neutralization to cause fibrosis to be used for intentional damaged tissue as fruit acid or alkali, and for example acid solution causes the sodium bicarbonate lavation neutralization of damage by dilution.

It is will the generation trichomadesis be set with standard in the male that palpus portion and neck area use the energize passage of relative depression or the potential benefit in change in organization's window/zone, reason is to design uniquely to cut the lower horizontal that section is placed on ball top, and this causes the destruction of ball top.Regrowth is hindered usually after described damage.

The aforementioned description of preferred implementation of the present invention and using method for diagram and explanation and be suggested and do not mean that be limit or limit the present invention to disclosed precise forms.According to above instruction many modifications and variations is possible.Embodiment is selected explains principle of the present invention and practical application thereof best with being described as, and allows others skilled in the art to use the present invention best thus in various embodiments and with the various modifications that are suitable for the particular desired purposes.

Claims (39)

1. facial take-up device comprises:

Axle with near-end and far-end;

Be positioned at least one sunk area of described far-end, each in described at least one sunk area can both be transmitted the energy that is used for chorista; And

Change in organization's window, described change in organization window can along tissue owing to separate at least one surface that described tissue produces in such a way to organizing transmission of power, the mode of described transmission of power can make the tissue of the tissue site that is positioned at a plurality of intervals be damaged, and wherein has the tissue of making and avoid destructive insertion zone between the tissue site at described interval.

2. device according to claim 1 is characterized by, and described window comprises at least a in electric energy, heat energy and the electromagnetic energy.

3. device according to claim 1 is characterized by, and described at least one sunk area can transmit the radio frequency electrosurgical current.

4. device according to claim 1 is characterized by, and described window comprises chemical energy.

5. device according to claim 4 is characterized by, and described chemical energy comprises acid.

6. device according to claim 4 is characterized by, at least a material of described chemical energy source in being selected from hypertrophy therapeutical chemistry product, sugar, saline solution, cleaning agent and acid.

7. device according to claim 4, it is characterized by at least a material of described chemical energy source in being selected from hypertonic glucose, sodium morrhuate, phenol, hypertonic saline, NaTDC, polidocanol, dodecyl sodium sulfate, monoxone and glycolic.

8. device according to claim 2 is characterized by, and described electric energy comprises at least a in monopolar current and the bipolar current.

9. device according to claim 1 also comprises being used for dissolving each the parts of tissue that are positioned at described at least one sunk area.

10. device according to claim 9 is characterized by, and the described parts that are used to dissolve tissue comprise the parts that are used to provide the dissolving energy.

11. device according to claim 10 is characterized by, described dissolving energy comprises at least a in electric energy and the electromagnetic energy.

12. device according to claim 10 is characterized by, described dissolving energy comprises ultrasonic.

13. device according to claim 1 also comprises the parts that are used for providing to the dissolving section of the described far-end that is positioned at described axle energy.

14. device according to claim 1 is characterized by, each tissue site disorganize that described window can be at least two tissue sites and not destroying at the tissue between each described tissue site.

15. device according to claim 1, also comprise at least one inductance sensor that is connected on the described axle, organize inductance around the described far-end of the described axle of described at least one inductance sensor sensing, wherein said pick off sends signal to control assembly, and described control assembly is controlled described energy delivery to described far-end, to regulate described inductance.

16. device according to claim 1 is characterized by, described window comprises a plurality of electrodes.

17. device according to claim 16 is characterized by, described a plurality of electrodes comprise at least six electrodes and no more than 20 electrodes.

18. device according to claim 16 is characterized by, at least one electrode in described a plurality of electrodes comprises insulated part.

19. device according to claim 16 is characterized by, at least one electrode in described a plurality of electrodes comprises at least a shape that is selected from down group: sharp cone distal, and wherein embedding of the base portion of larger diameter or countersunk head are in described axle; Cube; Pyramid; Hemispherical, have the sphere of cylinder join domain; Non-point is cylindrical; Mane shape; Bifurcated mane shape.

20. device according to claim 1 also comprises the parts that are used to limit the spendable number of times of described device.

21. device according to claim 1 is characterized by, described window comprises the dome that is coated with insulator, and described insulator comprises at least two holes, and energy can be transmitted in each hole in described at least two holes.

22. device according to claim 1 is characterized by, described window comprises the parts that are used to provide the gating energy.

23. device according to claim 22 is characterized by, described gating energy is with the speedgate of 1Hz to 200Hz.

24. device according to claim 1 also comprises the parts that are used to provide refrigeration material.

25. device according to claim 13 is characterized by, the described energy that is used for described dissolving section comprises electromagnetic energy.

26. device according to claim 13 is characterized by, the described energy that is used for described dissolving section comprises the radio frequency electrosurgical current.

27. device according to claim 4, it is characterized by, described chemical energy source is in being selected from the chemical substance, the tissue injury's chemical substance that cause tissue inflammation, causing Fibrotic chemical substance, float, insoluble particles, soap, microorganism, plant, animal, gas, liquid and causing at least a material in material, fat, substrate, oil, collagen, sand, glass and the plastics of fibroblastic growth.

28. device according to claim 1 is characterized by, described window comprises ultrasonic energy.

29. a device that is used to carry out the face wrinkle-smoothing operation comprises:

Axle, it has near-end and far-end;

Be positioned at a plurality of protruding members of described far-end; And

Be positioned at sunk area between each described protruding member at described far-end, in the described sunk area each can both transmission of power, be used for along described far-end chorista, wherein, described a plurality of protruding member and described sunk area are disposed for dissolving the tissue in a plane basically, and projection and depression are defined as watching from least one visual angle relatively.

30. device according to claim 29 is characterized by, described energy comprises at least a in laser energy, radio frequency electrosurgical current and the electromagnetic energy.

31. device according to claim 29 is characterized by, described axle comprises flat basically first surface and flat basically second surface, and described flat basically first surface is relative with described flat basically second surface.

32. device according to claim 29 is characterized by, described protruding member comprises globular protruding member.

33. device according to claim 29 also comprises the power transfer zone, described power transfer zone location also is structured on the described axle, is used for the pass through surface that become tissue plane produce described separate tissue of power transfer to tissue.

34. device according to claim 33 is characterized by, described power transfer zone can electric energy transmitting, at least a in heat energy, electromagnetic energy and the chemical energy.

35. device according to claim 33 is characterized by, described power transfer zone comprises the array that single energy transmission is formed.

36. device according to claim 35 is characterized by, the array that described energy transmission is formed can change tissue in each place in a plurality of tissue sites, makes simultaneously between each described tissue site to have less relatively change in organization.

37. device according to claim 29 is characterized by, described axle comprises a plurality of sunk areas that are positioned at described far-end.

38. device according to claim 29 is characterized by, described energy comprises ultrasonic energy.

39. device according to claim 29 is characterized by, ultrasonic energy can be transmitted in described power transfer zone.

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